The purpose of this research is to identify what visiting nursing station managers are doing to help visiting novice nurses develop competence and to clarify the process of their involvement. This research has shown the existence of five different categories of involvement such as the core category-" to support nurses in gaining confidence and making themselves overcome their own feelings of "Yuragi". "Yuragi" is a new concept of this research with the meaning of confused state of mind which novice nurses feel in their practice as a visiting nurse, that is different from the role of hospital based one. In this research, it was found that managers were very supportive in helping novice nurses develop their own skills needed for their nursing practice.

The purpose of this study was to examine factors related to job satisfaction of mid-career nurses working at acute care hospitals from aspects of intrinsic job satisfaction facet, extrinsic job Satisfaction facet, and individual attributes. The participants were 607 nurses working for 4-10 years at acute care hospitals. Based on Takahashi's criteria that developed from Herzberg's theory of motivation, two factors, “work itself” and “recognition,” from intrinsic job satisfaction facet, and three factors “organization's administration and policy,” “expected level of achievement for job placement,” and “quantitative workload,” from extrinsic job satisfaction facet were used to explain job satisfaction. The questionnaire consisted of 18 items of JIG (Job in General) original scale, 29 items of “recognition,” 11 items of “quantitative workload” from NIOSH Generic Job Stress Questionnaire, and 48 items of the Japanese version of Stamps's job satisfaction scale by Ozaki. Our main results were: of the seven factors of job satisfaction, “mutual influences among nursing staff” and “position in the organization” were rated highly, while “salary” and “nursing work” were rated low. Pearson's correlation coefficients showed that “work itself(r=0.561),” “recognition(r=0.531),” and “quantitative workload(r=-0.097)”were related to job satisfaction. Results of multiple regression analyses indicated that job satisfaction was not predicted by“organization's administration and policy,” “expected level of achievement for job placement,” nor by individual attributes. For the improvement of job satisfaction, the importance of enriching the substance of the work itself, and of recognition by others, particularly superiors, was clarified. Also suggested was the necessity of alleviating the quantitative workload.

The present study focused on nursing departments in the periods before and after the introduction of DPC in an attempt to clarify how the departments perceived staffing and staffing operations and developed plans and measures to address staffing issues. Subjects were seven nurses (directors, vicedirectors, and managers) working at two advanced treatment hospitals in the Kanto region. Semistructured interviews were conducted in order to summarize the facilities and nursing departments and ascertain the changes in staffing in nursing wards. The results clarified the following: 1) the first project for the nursing departments was to increase staffing, which was facilitated by a strategic shift in the structure of the nursing departments and the hospital upper management; 2) the foundation of staffing operations was top-down under the leadership of the director, but its operation required managers with strong management skills; and 3) staffing development created new problems, and human resourcerelated problems were continuously identified. Therefore, changes in medical environments clarified the effects of countermeasures for staffing issues as one of the problems facing nursing organizations. Furthermore, new problems and issues that must be addressed were identified. Addressing staffing issues is an effective measure for the current personnel, and the basic approach of the nursing departments was to provide high-quality care to patients. Therefore, staffing is one of the techniques that can be utilized by management to provide high quality care.

[Objectives]

Shiga prefecture has been promoting the Home Care System since receiving a business grant from the Ministry of Health, Labour and Welfare in 2004. However, the reality is that only a few hospitals in Shiga prefecture conduct functional discharge plans.

The purpose of this research is to investigate the actual condition of their discharge planning system, including their community liaison system, and discover the current situation and issues prohibiting the Home Care System in Shiga prefecture from conducting functional discharge plans from all hospitals.

[Methods]

An autographic questionnaire survey was conducted in all 61 member hospitals of the Shiga Prefecture Hospital Association. The results were analysed using SPSS Ver10.1.

Hospital names were kept confidential and the results were classed as general for ethical reasons.

Survey documents included survey request forms, details of the study plan, and consent and consent cancellation forms. Documents were mailed to the subject hospitals then written consents were collected.

[Results]

Hospital management were well aware of the importance of discharge planing and community liaison. A Discharge Planning Section was found to be present in approximately half of the hospitals. (Response rate of 86.9%)

However, it was found that most hospitals had difficulty with smooth discharge mainly due to rejection by families and shortage of community institutions and medical resources.

It was also found that the liaison between medical institutions and the community was not yet well structured. This unstructured community liaison seemed to complicate solving the issues of low family care capabilities and shortage of community resources.

[Conclusion]

The following are suggestions for promoting the Home Care System:

-Set up a Discharge Planning Section for each hospital

-Educate staff and allocate appropriate personnel

-Create more community resources and structure community networks

-Hold joint meetings with the community and develop community liaison pathways

The purpose of this study is an examine factors to be related to the job satisfaction of the nursing in the small or middle scale hospitals in low population density areas in Hokkaido. We got 186 questionnaire answers from 274 nurses of 5 hospitals and analyzed 149 effective answers. We took a factor analysis, an order correlation analysis of Spearman, a multiple regression analysis and showed relative strength with the job satisfaction. Result, five factors were adopted. We showed it in a pass diagram. In conclusion the strongest relationship factors of job satisfaction were “the conditions of work” of six items.

The aims of this study are to discover effective ways for nurse administrators to cope with work stressors during periods of change, and to clarify the connection between means of coping with stress and success at work.

The survey mailed anonymous, self-administered questionnaires targeting 295 nurse administrators(nursing directors, head nurses, and nursing officials) working in general hospitals of 200 beds or more in the Kyushu administrative district. Responses were received from 270 people (a response rate of 91.5%), providing a target for analysis of 238 people (a valid response rate of 88.1%) The subjects included a summary and the attributes of the target's facility, stress coping methods, and success at work. The study compared stress coping methods and success at work by job classification, confirming connections between the two, and then implemented one-way analysis of variance. Results are as follows.

1. "Human relationships" and "the heavy burden of work" came top of the list of nurse administrators' work stressors. Classified by job type, the most common responses were "increased duties in anticipating organizational change" from nursing directors, and "human relationships" from head nurses and nursing officials.

2. Problem-focused forms of coping featured significantly higher among nursing directors than among nursing officials, and emotion-focused forms featured significantly higher among head nurses than among nursing directors.

3. The group that was successful at work was significantly more likely to take direct action and information seeking approaches to problem-focused forms of coping.

The above suggests that coping with stressors during periods of change, and taking direct action and information seeking approaches to problem-focused forms of coping strengthen an individual's ability to cope. It also suggests that building support systems enables success at work.

The purpose of this study was to clarify nurse burnout, nurse turnover, incidents/medical accidents, and the relationship between nurse turnover and incidents/medical accidents following the introduction of the Diagnosis Procedure Combination (DPC) in 2003. A questionnaire survey was conducted of nurses and nursing managers working in 243 hospitals that had and had not introduced DPC. No statistically significant difference was found, indicating that burnout does not increase with the introduction of DPC. In the hospitals that had introduced the DPC, the nurse turnover rate was compared before and after DPC was started, but no significant difference was found. The introduction of DPC does not appear to increase nurse turnover. Similarly, statistical tests were conducted for incidents/medical accidents using the number of reported incidents/medical accidents summarized for each hospital. The relationship between nurse turnover and incidents/medical accidents before and after the introduction of DPC was tested using Pearson's product-moment correlation coefficient, but almost no correlation was found, either before or after the introduction of DPC, indicating that they are not related.

The objective of this study is to examine the types of tacit knowledge that nurse managers accumulate through their experiences and then actually practice to improve nursing services on the wards. Participant observation and semi-structured interviews were conducted with three nurse managers working at Hospital A, and the data were analyzed qualitatively to explore their insights and intentions about nursing services. Eight categories and twenty-two subcategories were distilled from the data. This paper describes nurse managers' tacit knowledge, which is the "key to change", used to implement effective nursing services. Integrating the staff's capabilities and the insights of patients and their families to acknowledge needs, nurse managers made the best use of the "key to change" to generate and enhance nursing services. This demonstrated knowledge leaders' wisdom when promoting innovations, and enabled them to improve nursing services while coping with changing nursing environments.

Results from analyzing distributions of the data showed that subjects tended to supervise the staff, and not to delegate authority in the supervision of chief clerks. This finding suggests that it is necessary for nurse managers to attend to matters beyond the wards, and to engage the whole organization in nursing service improvement.

The purposes of this study were to examine the relationships between self-education ability and nursing practice, and to find essential learning contents that would allow nurses to continue their professional work. I carried out an unsigned self-report inventory survey of 550 nurses with more than 3 years of experience, working at 11hospitals, each with more than 200 beds, in ‘A' prefecture. Selfeducation ability was measured using a 40 item scale by Kajita & Nishimura, and nursing practice was evaluated by 73 items with 6 sub-scales developed by Shibata, et al.

The total score of self-education ability showed a significant positive correlation with the total of nursing practice. Sub-scales of relaxing patients, responding, supporting patients to make use of strength, being aware of purpose, adjusting situations to individual patients were correlated significantly with 8 items of self-education ability. The items of "skills and basis of study", such as discussion with other people to deepen ideas, referring to objectives for evaluation, understandable explanation to others, investigate suitable study methods for each subject, were included.

These findings suggest that an educational support system is necessary to improve self-education ability.

In this study, female nurses who work at hospitals with over 200 beds in general ward in the Kanto region were subjects to an investigation conducted on what kind of illnesses hospital nurses were receiving treatments for, in order to clarify the health situations of nurses working at hospitals. The results of the study were as follows:

(1) Out of the 8,328 nurses working at hospitals, 3,614 (43.4%) were currently under treatment for any illness.

(2) Among the hospital nurses currently under treatment for any illness, they include: (1) those with diseases of the respiratory system (303 nurses); (2) those with diseases of the ear and mastoid process (303 nurses); (3) those with bone and joint and connective tissue disorders (194 nurses); (4) those with diseases of the skin and subcutaneous tissue (188 nurses); and (5) those with diseases of the circulatory system (132 nurses).

(3) Among the nurses with illnesses currently under treatment, many of them were significantly older in age, had more experiences, were on night shift, were smokers, and were cautious of taking balanced meals.

Aim: We aimed to build up a support system for novice nurses in pediatric wards in university hospitals with clarifying their feature with their variation of assertiveness score and burnout score within a year after their employment.

Methods: Informed consents for participating in our study were given to 1,203 novice nurses. The questionnaires, which dealt with burnout, assertiveness, reality shock, ward assignment preference, transfer preference, job satisfaction were completed by 923 novices in June 2003 and 2004.

Results: Fifty nurses (47 females and 3 males) among them were novice nurses in pediatric wards. The average age of them (23.1 years old) was not significantly different from that of novice nurses in other wards (22.8 years old).

Novice nurses in pediatric wards were significantly characterized from those in other wards on "graduate from university" (p<0.05) "living with family" (p<0.01)" satisfied with their ward assignment preference" (p<0.01) and "feeling satisfied with their caring patients a year after employment" (p<0.05).

In the baseline, the novice nurses in pediatric wards tended to be lower in assertiveness and higher in burnout risks than nurses in other wards. However within a year after their employment assertiveness points were raised higher and their burnout risks were reduced more than nurses in other wards.

Conclusions: For novice nurses in pediatric wards, satisfaction with their ward assignment preference can contribute to feeling satisfied with their caring patients a year after employment, raising up in assertiveness score and reducing in burnout score.

Approximately one decade ago, amid ongoing economical globalization and a shrinking, aging population with low birth rates, Japan adopted legislation allowing non-profit organizations (NPOs) to respond to the demands and needs for nursing services aimed at the elderly.

The present paper seeks to shed light on the true nature of NPO activities and services by examining the traditional model for NPOs, the meaning and economic characteristics of NPO services and the actual situation of NPOs.

The economic characteristics of NPO services are clearly different from services provided by governments and enterprises–NPOs flexibly provide diverse services in order to achieve their mission through organizational activities in which individuals voluntarily choose to participate. "Non-profit" in the context of NPOs means that there is no distribution of profits. Legislation in Japan enables NPOs to provide community-oriented, small-scale and multifunctional in-home care as public services. These pioneering nursing services are beginning to spread across Japan today.

This paper examines the meaning and economical characteristics of NPO activities and services carried out by nurses from the standpoint of achieving a better quality of life for each individual and contributing to the maintenance and advancement of healthy lifestyles.