An ongoing prospective cohort study of female nurses working in the Kanto region of Japan was conducted at 93 hospitals, each of which had no fewer than 200 beds in its general ward, to demonstrate the factors that contribute to nurse turnover. In a follow-up survey conducted six months later, the cooperation of nursing directors from 75 hospitals was gained and subsequently, responses from 5,387 nurses out of 8,327 nurses from the 93 hospitals, which participated in the baseline survey, were collected. Among the 3,756 nurses who met these three requirements: worked as a nurse, worked the night shift, and worked in a hospital ward, 3,456 responses to a questionnaire about accidents and/or incidents experienced in the past six months were analyzed. The findings of the logistic regression analysis showed that nurses who worked the night shift and always worked overtime experienced accidents and/or incidents 1.734 times more often than nurses who reported no overtime (95% confidence interval, 1.024-2.983, p=0.041), and that nurses who reported being absent due to sickness during the previous six months experienced accidents and/or incidents 1.347 times more often than nurses without any absences (95% confidence interval, 1.044-1.737, p=0.022). Regarding health statusrelated quality of life (QOL), when limitations at work due to changes in mental function were improved by one point, the frequency of experiencing accidents and/or incidents increased 0.995 times (95% confidence interval, 0.992-0.998, p=0.004); as well, when limitations in social function were improved by one point, the frequency of experiencing accidents and/or incidents increased 0.993 times (95%confidence interval, 0.987-0.998, p=0.006).

The purpose of this study is to revise the assessment score sheet for patients falling over in the hospital and clarify the reliability among the nurse evaluators. We investigated the assessment score sheet data of patients falling over (pre-revised sheet) based on statistic technique and made the revised sheet. As a result, the revision sheet selected 7 classifications and 19 items based on multiple logistic regression analysis and put weighed code on the items based on the odds ratio. The sensitivity, the specificity, and the area under the ROC curve (AUC) of the pre-revised sheet were 72.7%, 74.9%, and 0.812, respectively, and those of the revised sheet were 74.5%, 79.6%, 0.822 respectively. By using the revised sheet two nurses carried out the assessment on a number of patients falling in the hospital respectively and examined the reliability among the evaluators. As attributes of the nurse evaluators, the average year of experience of the head nurses is 20.0±6.2 and that of the staff nurses is 7.5±7.4. The data has a significant difference. (p<0.001) However, the average of total points on fall patients assessment scores did not have a significant difference.(p=.0.645) Intra-class correlation coefficient is 0.97. The Kappa coefficient (K coefficient) of the agreement among the nurse evaluators, which is smaller than 0.61 is 2.0% and the coefficient which ranges from 0.61 to 0.80, is 22.4%. And the coefficient which ranges from 0.81 to 1.00 is 75.5%. We conclude that falls in the hospital can be predicted more accurately by the revised sheet with smaller items. Because the agreement of the prediction by revised sheet among the nurses' evaluations is quite high, the fall rate can be predicted reliably regardless of nurses' experience.

The objectives of this study are to examine how ward nurses working at medical institutions organize time during their daily duties, and to exploration thought factors involved in actual time management. A semi-structured interview was conducted with five ward nurses working at the neurosurgery departments of university hospitals. Data collected from the interview were supplemented with direct observations of the nurses while performing their duties. The results showed that thought factors involved in time management in nursing fall into four categories, namely, “Preference on the basis of the patient\'s course”, “Facilitation of team activities”, “Implementation of effective care” and “Improvement of work efficiency”. Furthermore, 13 sub-categories were extracted. It was suggested that inexperienced nurses require sufficient supervision to implement time management.

The present study aimed to clarify the difficulties experienced by new head nurses in regular nursing management tasks, and what kind of role models former head nurses served as when coping with such difficulties. Semi-structured interviews were conducted on eight new head nurses and qualitative induction was used to analyze the interview data. As a result, 10 categories of difficulties experienced by new head nurses during regular nursing management were generated. Among these, an ideal role model could be confirmed for 6 categories. These six ideal role models were applied when they copy with the difficulties. The correspondences between difficulties and the role models were as follows. “Nursing management tasks requiring patient information / Head nurse able to capitalize on understanding of patients”, “Incomplete relationship with deputy head nurse / Head nurse with close interaction with deputy head nurse”, “Career support for staff nurse who have a sense of inadequacy / Head nurse able to make the best use of staff nurse's skills”, “Barrier to communication with staff nurse / Head nurse able to build a good relationship with staff nurse”, “Behavior as head nurse who cannot express one's will / Generous and rational head nurse” and “An suitable declaration of intention and directions as leader who can't show it. / Head nurse able to embody their convictions and lead staff nurse”. Difficulties for which a role model was unable to be confirmed included “Lack of experience that makes nursing management tasks confusing”, “Reshuffle as promotion which difficult to determine if it is right”, “Unclear categorization of nursing and head nurse tasks”, “Passive feelings accompanying promotion”. From the analysis, it becomes clear that new head nurses have difficulty with their situation which request complex and highly management abilities. They recollected the head nurse who was able to build the interpersonal relationship and exercise leadership as a role model. These findings suggested the necessity of establishing a nursing management education system and individual supporting systems to learn the way of observing role models consciously and draw a parallel between the role model and themselves.

The present study was intended to investigate the experiences of nurses in care scenes where they had negative feelings toward patients or their families. A self-administered questionnaire was used to ask about when, how, and why they had negative feelings to patients, as well as what helped them cope with or made them react to such feelings. It was distributed to 27 master course students who had worked as staff nurses, and 14 of them responded. The responses indicated that they tended to have negative feelings toward a patient when the patient communicated one-sidedly to them. The causes for their negative feelings they indicated were an action/behavior against social norm or common sense, an egocentric manner of the patient, and a demand disregarding feasibility by the patient and the family. They responded that they could manage the negative feelings and related suffering by an objective view of the situation and support from their superiors, or reacted according to a situational demand without choice. The tended to have a feeling of imperfection that they could not practice the care they aimed at, the sense of incongruity caused by the inconsistency between their sense of nursing values and what they felt, and a feeling of ineffectualness that they failed to meet a social request. However, objective observations on their situation enabled them to continue participating in the care for the patient while having negative feelings. Support by superiors and colleagues is necessary for helping the nurses observe their situation objectively, and thereby evade too serious suffering caused by awareness of having negative feelings toward a patient, and make use of the opportunities to enrich their carrier.

Objective: Review of previous studies examining WFC among nurses in Japan and overseas with the following aims: 1) To clarify research issues related to WFC among Japanese nurses. 2) To gain practical suggestions on how to reduce WFC and steps that should be taken to create a work environment enabling nurses to work and have a family life.

Method: Sixteen papers were selected from CINAHL and Igaku Chuo Zasshi. Researchers, publication dates, study designs study methods, subject attributes and numbers, ways of dealing with WFC, factors increasing WFC, outcomes due to increased WFC and other data were examined (Table 1).

Results, Discussion: 1) It was found that increased WFC among nurses leads to a wide range of negative outcomes among both individual nurses and nursing organizations overall. 2) WFC among nurses is a heavy occupational burden. Since this increases when there is little support, it is possible that steps such as examining various forms of employment suitable for individual lifestyles, the establishment of systems to eliminate overtime, and the fostering of organizational culture that supports nurses at work and in the home, could reduce WFC. 3) It is hoped that future studies of WFC among nurses will use broader sampling with more unified attributes and study designs with a high level of evidence, and examine the relationship between an organizational culture that supports nurses at work and in the home and the degree of physical and mental well-being.