Aim: To assess the reliability and validity of the Self-Assessment Scale of Competency for Nurse Educators (SS-CNE) Ver. 1 who support novice and their preceptors.

Method: Nurse educators were requested to complete the 40-item SS-CNE Ver. 0 and the 16-item General Self-Efficacy Scale (GSES). We mailed 1030 questionnaires to 310 hospitals and received 615 forms back (59% response rate). Of these, 550 were complete and could be used to analyze factor validity, internal consistency and stability, and concurrent validity.

Results: Factor analysis revealed four factors across 27 items: The first factor was the ability to organize management and self-management for On-the-Job Training (OJT) (10 items), the second was communication ability as the foundational support for relationship building (6 items), the third was educational ability based on nursing practice ability (6 items), and the fourth was the ability of consulting the preceptors (5 items). Reliability testing demonstrated a high internal consistency with a Cronbach's alpha of 0.932, and a high Spearman's correlation coefficient for test–retest of 0.861 and SS-CNE Ver. 1 and GSES of 0.355.

Discussion: Factors revealed by SS-CNE Ver. 1 included the educator's capacity and educational power, which facilitate the problem-solving ability of nurses. The SS-CNE Ver. 1 may be useful as a self-assessment of competencies among nurse educators, or for evaluating their educational program.

Conclusion: We confirmed the reliability and validity of the 27-items SS-CNE Ver. 1 for assessing competencies among nurse educators' self-assessment and for the evaluation of their educational programs.

It is necessary to grasp both structural and psychological empowerment for the overall understanding of empowerment in the workplace. Psychological empowerment is the employee perceptions of their power to cope with the events and situations they encounter at work. The purpose of this study was to investigate the internal consistency, structural validity, and convergent validity of the newly developed Japanese version of "the Psychological Empowerment Scale" (Spreitzer, 1995). The questionnaires were distributed to 1615 nurses working at 7 hospitals and 3 geriatric long-term care facilities, and the data of 865 respondents without missing answers were analyzed. Cronbach alpha coefficients of the Japanese version of "the Psychological Empowerment Scale" and its 4 subscales were 0.82-0.90. Exploratory factor analysis revealed that the Japanese version of "the Psychological Empowerment scale" is composed of either 3 or 4 factors, and confirmatory factor analysis confirmed to have 4 factors. However, this 4-factor model did not have a good fit, thus a modified 4-factor model was created according to modification indices. Fit indices for the modified 4-factor model were RMSEA=0.08,CFI=0.96,and TLI=0.94. Correlations of the Conditions of Work Effectiveness Questionnaire-II with the Japanese version of "the Psychological Empowerment Scale" and 4 subscales were 0.39, and 0.20-0.40 (p<0.01), respectively. The Japanese version of "the Psychological Empowerment Scale" showed good internal consistency, along with fairly good construct and convergent validity. Therefore, this scale could be applied to assess psychological empowerment among Japanese nurses.

Objectives: The aim of this study is to examine the effect of organizational recognition by giving opportunities such as enhancing the expertise of nurses and midwives or giving them autonomy to increase their motivation and desire to work at their hospitals as long as possible.

Method: We conducted a questionnaire survey for 115 midwives working in three tertiary emergency medical institutions, three secondary emergency medical institutions, and a clinic midwife facility, and for 123 nurses working in a tertiary emergency medical institution. We received responses from 89 nurses (recovery rate 72.4%) and 111 midwives (recovery rate 96.5%). We conducted an exploratory factor analysis and thus identified three factors of organizational recognition by giving opportunity, which were called "acquisition of expertise," "granting roles in the ward," and "granting autonomy." The main analysis was conducted using multiple-group structural equation modeling, in which three types of organizational recognition were set as independent variables.

Results: Granting autonomy increased the motivation of nurses via increasing their will to continue to work as an organization member, but for midwives it increased their will to continue to work as a professional. In both, acquisition of expertise directly enhanced their motivation.

Discussion: Whichever occupation participants were in, organizational recognition by being given the opportunity to enhance their autonomy and expertise was important to maintain and improve their work motivation. The finding that in midwives, granting autonomy increased their will to continue to work as a professional, but not as a member of the organization, suggests that hospital organizations need to encourage midwives in a different manner.

Objectives: To elucidate the process and characteristics of in-patients' anger toward nurses.

Methods: The research design was a multiple-case study. Based on previous studies, we first constructed a model regarding how in-patients evoke and process anger toward nurses. We then conducted approximately 1-hour semi-structured interviews 2–3 times with each of the nine persons who had felt anger toward nurses during hospitalization at a general hospital.

Results: The in-patients first realize the damage inflicted by the nurses, such as "insufficient explanation," "insensitivity to the sense of shame," "insensitivity to feelings and circumstances," "insufficient information sharing among nurses," "economic loss," "life-threatening crisis," "disrespect to behavior," and "disrespect to dignity." Before developing feelings of anger, they additionally assess the responsibility of the nurses for the events that occurred. The aroused anger is subsequently processed by two cognitive processes—immediate cognitive processing and deliberate cognitive processing—to decide whether or not to express anger and how to express it. In deliberate cognitive processing, one cogitates "legitimacy of anger expression," "post-expression outcome prediction," and "nurse's awareness on discomfort experienced by the patient." In some cases, the anger is expressed as "direct aggression," "indirect aggression," "redirected aggression," and "non-aggression." In other cases, expression is suppressed as "non-acting out." It was shown that the second choice behavior is taken when the first choice behavior fails to abate anger.

The purpose of this study was to verify the relationships linking implementation of the PDCA cycle for end-of-life care in nursing homes, nursing ability and the results of end-of-life care based on a model for administrative evaluation of nursing care. A further aim was to identify factors toward the improvement of practical nursing skills. A total of 256 administrators of nursing homes registered as National Council for Elderly Welfare Facilities were invited to take part in the study's self-reported questionnaire survey, the evaluation model was verified using structural equation modeling. The factors identified for practical nursing skill improvement were 1) consideration of easily understandable explanations, guidelines and plans for end-of-life care in nursing homes, and securement of agreement from residents and their families, and 2) regularization of meetings with staff and families for reflection after a resident passes away. These factors are expected to promote the PDCA cycle for end-of-life care in nursing homes.

[Aim] To describe nurses' perceptions about working overtime and the related factors, and to investigate the relationship between these factors.

[Methods] We conducted a questionnaire survey of 2,408 general nurses from 164 hospitals that cooperated with this study among the 774 hospitals nationwide. They were extracted using proportional allocation with stratified random sampling. A factor analysis was conducted on nurses' perceptions about working overtime and nurses' perceptions of factors related to working overtime. We identified causal associations between the factors using structural equation modeling.

[Results] The subjects of this study were 1,497 general nurses (valid response rate: 62.2%). The factor analysis results were comprised of four factors for nurses' perceptions about working overtime and seven factors for nurses' perceptions of factors related to working overtime. The results of the structural equation modeling indicated that the large amount of work outside of patient care had the greatest effect of making nurses aware of the four factors of perceptions about overtime work (β=0.430–0.761, p<0.05). Meanwhile, the organizations' proactive approach about working overtime greatly affected the reduction of nurses' desire to resign if the current overtime work remained unchanged (β=-0.518, p<0.05), exceeding the large amount of work outside of patient care (β=0.457, p<0.05).

[Conclusion] This study indicated that organization of the workload outside of patient care, the involvement of nursing administrators, and changing the way the organization operates to enable nurses to feel the organization's proactive approach to working overtime may alleviate the sense of burden of overtime work for nurses.

Since the Partnership Nursing System (PNS) was introduced to academic journals for the first time in 2012, it has been adopted by many hospitals. This study aims to clarify the positive feelings among nurses working in pairs under the PNS, and the factors related to positive feelings toward working in pairs. A questionnaire included items on personal attributes, the type of nursing system implemented (presence or absence of the PNS), positive feelings related to working in pairs, positive relationship with a year-round nurse partner, and the nursing practice ability scale. After obtaining 1530 (85%) responses, the data of 523 participants from the general ward working in a PNS were analyzed. The total score of positive feelings associated with working in pairs was 19.2 ± 4.0 points (range 6-25), and the score distribution was biased toward high scores. Multiple regression analysis results revealed that the following factors are important for enhancing positive feelings related to working in pairs: relationship with a full-year nursing partner (β=.44), nursing practice ability (β=-.16), title of chief nurse (β=.17), being a parent (β=.17), having nursing experience exclusively under the PNS (β=.18), and nurse has less experience than full-year nursing partner (β=.15). Nurses who had anxiety about their nursing practice abilities, and nurses with children, demonstrated positive attitudes about working in pairs. The findings of this study present one of the selection criteria for considering introduction of a PNS.

Our aim was to study whether a team approach would improve discharge planning by ward nurses. A self-administered questionnaire was mailed to 463 nurses working in 22 wards at six institutions in prefecture A. The questionnaire included the Discharge Planning of Ward Nurses (DPWN) rating scale, originally- developed questions on the team approach, questions on personal characteristics and experience, and questions about the ward where the nurse works. Three hundred three nurses (65.4%) returned the questionnaire, and 263 questionnaires (56.8%) with valid responses were analyzed. The mean age of the respondents was 34.5 (±10.1) years; 38.1% of the respondents were in their 20s and 28.7% were in their 30s. Four factors related to ward nurses' team approach were extracted : self-awareness and behavior as a specialist, recognition of the importance of maintaining a team approach, maintaining good relationships among coworkers, and difficulty in working with other specialties. Self-awareness and behavior as a specialist (β=0.528), introduction of clinical pathways (β=0.169), learning experiences in discharge planning (β=0.127), and introduction of electronic charts (β=0.113) were identified as factors that would assist nurses with discharge planning. These data suggest the importance of enhancing each nurse's self-awareness and behavior as a specialist, the usefulness of systems such as clinical pathways and/or electronic charts, and learning experience in improving discharge planning by nurses.

In Japan, only a small number of nurse managers work in medium-sized hospitals, and they face difficulties supervising staff with diverse educational backgrounds and experiences. However, it is difficult for these managers to participate in training programs outside their own institutions. In the United States, the servant leadership demonstrated by mid-level nursing leaders has been shown to facilitate professional development and to improve job satisfaction among nursing staff. In this study, we developed and evaluation a pilot for a support model for nurse managers. The support model combines group training at the time of day when work is relatively quiet and cloud environments to promote self-learning. The model was tested on 47 nurse managers who consented to participate in the study; the managers worked at 4 institutions where the nurse directors had an understanding of the study. Forty-five nurse managers responded to a questionnaire after using the support model (response rate 95.7%). Participant self-assessed servant leadership skill scores increased significantly (P<0.05) from 190.9 points (±19.9) before participation to 197.0 points (±22.3) after. Participants provided many positive comments on the model's use of cloud environments, including "Easy to participate" and "Learned at my convenience." These results confirmed the effectiveness of the support model.

Objective: We have systematically worked on laying the foundation to implement projects that support development of medical professionals by using a network of university and medical facilities. The objective is to acquire new knowledge to develop a future nursing consortium based on the results.

Results: 1. A field survey on development of experienced nurses was conducted targeting medical facilities in City B with which agreement was formed to discuss on the concept of nursing consortium with University A. 2. "Training for nurses in the vicinity of City B to deepen discussions and exchanges through class observation at a university" was conducted based on the training needs obtained from the survey results. 3. "Training to connect a remote location and a university by Skype" was conducted. Respective results were confirmed and have been incorporated in the annual training plan at each medical facility.

Discussion: A university that have been developing a foundation for relationships since opening as well as medical facilities systematically assigned people in charge to train experienced nurses, and the project is moving into a constructive stage including refinement of the planning content.

Conclusion: Creation of a place for both the university and medical facility to propose and examine business plans is the issue for the nursing consortium to continue its activities. Regarding a stable project of a university, a structure needs to be maintained such as organization and budgeting.

This study aimed to evaluate the effect of an educational program named "Care for dementia patients focusing on the viewpoint of elderly patients" for consenting nurses in general wards in the acute care hospital. This program is based on common ideas and skills among person-centered care, humanitude, and tactile care, and set the principal of "Respecting patients and being close to them." We divided participants into intervention and control groups by ward. Participants of the intervention group underwent the educational program using a paper sheet and a DVD, and provided care to their patients based on this program for three months. Control group provided usual care to their patients for three months. All participants responded questionnaires at baseline and after three months. We analyzed the change scores in difficulties consisted of five factors of nurses in caring symptoms related to dementia.

Twenty-six nurses in control group (response rate, 68.4%), and thirty-nine in intervention group (response rate, 97.5%) were analyzed. In the change scores of "feeling of difficulty in treating agitated and hyperkinetic behaviors," intervention group significantly decreased than control group (median of intervention group, -5.0; median of control group, 0.9; p=0.03). Then, it is suggested that this educational program is effective in reducing "feeling of difficulty in treating agitated and hyperkinetic behaviors".

This study aimed to clarify 1) the proportion of nurses who stutter (NWS); 2) knowledge regarding stuttering on the part of nurses who do not stutter (NWNS), and their perceptions and attitudes regarding people who stutter (PWS); and 3) what NWS think about their difficulties on the job and the work environment, and to identify ways of improving their work environment. This study targeted nurses from 10 hospitals, each with fewer than 200 beds, in Tokyo's 23 wards. Of the 575 nurses surveyed, 290 completed anonymous questionnaires covering characteristics, stuttering status, knowledge of stuttering, and perceptions and attitudes regarding PWS. Thirteen of 290 participants (4.5%) were NWS, and reported difficulties in their work and work environment. Moreover, although 70% of NWNS knew the term "stuttering," they had insufficient knowledge of its symptoms and epidemiology. There were no associations between knowledge, perceptions, and attitudes regarding PWS; however, exposure to PWS was associated with some perceptions and attitudes regarding PWS. Eight of 13 NWS answered the question about perceived difficulties at work. Four NWS experienced severe difficulties, whereas the other four did not. The former tended to confide in their co-workers about their stuttering and the need to be understood and considered by them; therefore, they were more satisfied with their workplaces compared to the latter. This suggests that the proportion of NWS is larger than that of PWS in the general population (1%), and some NWS are not understood or considered by co-workers and are not satisfied with their workplaces.

Purpose: Purpose of this study was 1) to evaluate educational engagement of clinical faculty during the clinical practicum; and 2) to gain understanding of the outcome of the newly implemented clinical faculty system.

Method: Adopting the Japanese version of Effective Clinical Teaching Behaviors Assessment Scale, an anonymous questionnaire was administered to nursing students who did clinical practicum under the supervision of clinical faculty (N=56), clinical preceptors who worked closely with the clinical faculty (N=25), and nurse managers from the units where clinical practicum occurred (N=13). Participants were asked to provide feedback in writing regarding educational engagement of the clinical faculty and the clinical faculty system.

Results: The results indicated that all three groups evaluated positively about the clinical faculty's Teaching activities. The students highly evaluated teaching contents that is relevant to clinical practice at the bedside. The faculty's facilitation for nursing inquiry was also evaluated highly. However, the results indicated that the nursing students were very nervous during the clinical practicum, the clinical faculty might need to pay attention to reduce tension in the environment for the nursing students. The clinical preceptors expected clinical faculty to be a bridge builder between theoretical knowledge and clinical practice. Nurse managers had expectations for the clinical faculty to contribute 1) to become a mentor for the clinical preceptors; 2) improvement of quality and skill level of nurses of the units; and 3) to help new graduates to successfully transition into staff nurses' role. Evaluation of the clinical faculty system, issues such as unclear role definition of the clinical faculty, and allocation of clinical faculty were identified.

Conclusion: Clinical faculty system and clinical faculty's educational engagement are positively received by the students, clinical preceptors, and nurse managers, which indicated that clinical faculty might bring a positive impact not only for clinical practicum for nursing students, but also for the staff nurses and the clinical units where clinical practicums take place.

This study aimed to show factors related to the burnout of midwives who work in maternity wards.

We conducted a self-rating questionnaire survey, and the participants were 614 midwives who were working in general perinatal medical centers or regional perinatal medical centers in the Kanto region of Japan. Question items surveyed in this study include ‘burnout: Maslach Burnout Inventory (J-MBI)', ‘personal demographic characteristics', ‘work-life-balance (WLB): Nursing WLB Index:N-WLBI', ‘workplace environment', and ‘severity of responsibility felt by the midwives'. In total 386 responses were collected (62.9%), the mean age was 34.7 (±10.0) years, and the total burnout score was 11.3. The results of the multiple regression analysis showed that the adjusted coefficient of determination was 0.40. Factors that were strongly related to burnout of midwives were ‘career development', ‘feelings of difficulty in the cooperation with physicians', ‘feelings of the burden of directly assisting in the delivery', ‘effort for self-realization', and ‘overtime' in the subscale of the WLB. The findings suggest that improvements of these items would reduce the risk of burnout of midwives working in maternity wards.

The purpose of this study is to clarify the factor structure of learning that nurses working at a hospital acquire from clinical education in order to develop and test the reliability and validity of the scale of leaning from clinical education of nurses. A questionnaire comprising 53 items was prepared through examination by nurse practitioners. The subjects of a questionnaire survey were nurses who work at hospitals in Prefecture A. Exploratory factor analysis was conducted with the principal factor method and promax rotation, and reliability and validity were confirmed with the Cronbach's α coefficient and confirmatory factor analysis, respectively. The number of responses was 720 (valid response rate=43.6%), of whom 88.6% were female and 11.4% were male. The mean working year and standard deviation was 16.3±9.1 years. Five factors for 20 items comprising the scale were extracted: [acquisition of basic nursing], [expanded view toward work], [self-growth as a person], [acquisition of competency to accomplish work at one's own department], and [acquisition of autonomy as a nurse professional]. Cronbach's alpha coefficient for reliability was 0.960, which cinfirmed internal consistency. The degree of compatibility of the model with confirmatory factor analysis was GFI=0.911, AGFI=0.883, CFI=0.956, and RMSEA=0.066. It was suggested that this scale is reliable and validity, and can be used to evaluate learning acquired by nurses from clinical education.

Objective: In our previous study, we developed a scale of nurses' learning from clinical education. This study aimed to test the cross-validation of the Learning Scale on In-service Education for Nurses.

Methods: A self-report questionnaire was administered to nurses working at hospitals. There were 435 participants (response rate: 38.6%). Surveys from 82 participants were excluded from the analysis because they did not answer all the questions. Finally, 353 questionnaires were used for the analysis. We examined the Learning Scale on In-service Education for Nurses, the Scale of Career Self-reliance Behavior, and social support in the workplace. Confirmatory factor analysis was performed to test the fitness of the model obtained from our previous study.

Results: The Learning Scale on In-service Education for Nurses demonstrated acceptable construct validity and internal reliability of its subscales. A path analysis showed that social support from a superior at work (path coefficient=0.23, p=0.01) directly predicted learning from in-service education. Career self-reliance behavior was explained by learning from the in-service education (path coefficient = 0.41, p < 0.01).

Conclusion: Using a different sample from our previous study, this study suggested that the scale is reliable and valid and can be used to evaluate learning acquired by nurses from clinical education. Social support from a superior at work may promote learning from in-service education. Moreover, learning may facilitate self-reliance behavior for career development.

A conceptual analysis of nursing administrator competency was conducted to elucidate the definition of this competency. Rodger's approach was used to conduct a conceptual analysis. MEDLINE, CINAHL, ICHUSHI web, and CiNii Articles were utilized to search for articles, and 35 papers published between 2000 and 2017 were analyzed. The results revealed six attributes: "competency in devoting oneself to maintaining the quality of nursing," "competency in reforming an organization," "competency in cooperating on the basis of a relationship of trust," "competency in developing and retaining human resources," "competency in maintaining an active attitude," and "competency in self-improvement." Antecedents were "education and experience as a nursing administrator," "how one perceives nursing administration jobs," and "organizational support for nursing administrators." Consequences identified were "improving the quality nursing care by staff nurses," "revitalizing departments and strengthening cooperation among divisions," "improving patient satisfaction," and "improving job satisfaction." Based on these results, the concept of nursing administrator competency was defined as "competency in reforming an organization while simultaneously devoting oneself to maintaining the quality of nursing, developing and retaining human resources, and cooperating by forming relationships of trust with others, as well as having an intrinsic attitude towards actively addressing matters and self-improving as a nursing administrator." This conceptual definition could be utilized to develop and appoint nursing administrators in the future.

The purpose of this study was to clarify the difference in competency by the nursing administrators' years of experience. The participants were 332 nurse supervisors who belonged to 33 A groups from all over the nation. The subjects were given the self-administered Nursing Administrator's Competency Assessment Scale (NACAS) developed by Motomura et al. The NACAS is composed of 25 items covering four types of competencies: problem-coping behavior competencies, interpersonal relationship competencies, target-setting competencies, and information collection competencies. As a result, the number of distributions was 332 and the number of collections was 312 (recovery rate 93.9%). Among them, 258 women with missing values and 284 women except 3 men were excluded (effective response rate was 85.5%). The subjects' average age was 49.8 (SD ± 5.7) years old, and the average years of nursing experience was 6.4 (SD ± 4.6) year. Countermeasures Behavior competencies shows the resolution of the problem situation in the organization that the nursing manager belonged to and the recognition of judgment and adaptability. It can be inferred that problem-solving behavior improves as the number of years of experience increase. Therefore, the competencies of nursing administrators differed depending on the years of nursing administrator experience, and it became clear that differences tend to occur often, especially in nursing administrators who have more than 15 years of experience.