This study aims to describe to consider nursing practice use by mid-career nurses, in particular to focus and clarify using life story, once they move from acute hospital to long-term care wards. Subjects included three such female in their early 40s. Subjects were interviewed about their best and most difficult experiences, and experiences that became turning points since beginning work with long-term care wards. Their stories were analyzed focusing on temporal, biographical, causal, and thematic coherence . The subjects had 6-10 years of experience in acute hospitals and 3.5-8 years with long-term care wards. They gained a sense of competence through their nursing practice at acute hospitals but experienced conflict due to the incompatibility with their private lives accompanying events that followed their transfer to long-term care nursing. They could not practice nursing as before with the long-term care wards, and experienced shock and confusion regarding their identities as nurses. However, they understood nursing for long-term care wards based on their own practice cultivated through prior experience. Results showed that it was essential for nurses to maintain a sense of competence to continue work with long-term care wards and find meaning by connecting their current practice to previous experiences, than adapting to long- term care wards. Further, it is important to reconstruct one's nursing care from past experiences, when transferring to long-term wards care, a change which includes one's private life profession.

The aim of this study was to clarify the relationship between professional autonomy in nursing and clinical occupational experiences of midwives employed in hospitals. Anonymous, self-administered questionnaire surveys were distributed by post to 1122 midwives employed in hospitals with delivery facilities in the Tohoku region. Survey contents covered personal attributes, work environment, clinical experience, quality of occupational experience, and professional autonomy in nursing. Relationship with autonomy scores was analyzed using multiple regression analysis.

The response rate was 46.1%, with valid responses from 469 participants (90.5%). The total autonomy score was 167.61 ± 24.61 points and the total work experience evaluation score was 94.47 ± 20.03 points. The five factors influencing increased professional autonomy in nursing among midwives were "experience establishing value standards as a nurse" on the occupational experience evaluation subscale, together with "acquisition of practical nursing abilities and experience in fulfilling various roles", "experience as a shift leader", "number of years' experience as a midwife", and "experience of engaging in research". In addition, approximately 45.6% of midwives working in obstetrics wanted clinical experience outside obstetrics, which may reflect a need for experience in other areas accompanying the increase in high-risk pregnant and parturient women.

When considering career development as a midwife, this study suggests the importance of carrying out continuing education that integrates factors that influence the development of autonomy, namely, "various roles", "shift leader", and "engagement in research", in addition to experience that contributes to confidence in midwifery practice.

Organizational learning (OL) differs from individual learning and is a process by which an organization acquires new information and knowledge, establishes routines, and changes its range of potential behaviors. OL is necessary for organizations to respond to complex situations and environmental changes throughout an entire organization.

The purpose of this study was to develop a Japanese version of the Measurement Scale for the Organizational Learning Subprocesses by Flores et al. (2012), a scale to measure the organizational learning taking place in a company, and to test its reliability and validity.

After obtaining permission from the authors, the scale was translated into Japanese and a back translation was reviewed and approved by the original authors. Subsequently, to verify reliability and validity an anonymous self-administered questionnaire survey was conducted for nurses in medical facilities. The survey was distributed to 266 nurses working in nine departments of a Japanese hospital, from August to September 2018. Responses were obtained from 239. Confirmatory factor analysis showed that the same five-factor/23-item structure demonstrated a reasonably good fit. The five factors were information acquisition, information distribution, information interpretation, information integration, and organizational memory. All of Cronbach's coefficient alpha for the subscales were over 0.7. Criterion-related validity, discriminant validity, and time stability were also confirmed. Thus, this Japanese version can be used as a scale of a Japanese version of organizational learning subprocesses.

The purpose of this study was to examine nurse managers' perceptions and participation behaviors in meetings, characteristics of meetings as influencing factors, acceptance of meeting results, and whether these factors were related. A nationwide anonymous self-administered questionnaire survey was conducted among directors of nursing and nurse managers working at 112 facilities having over 300 beds. In total, 97 nurse department managers (response rate 86.6%) and 1010 nurse managers (response rate: 55.4%) returned the completed questionnaire. Eighty-one percent of the respondents replied that nurse administrator meeting was a place for decision-making by the nursing department while 44.6% recognized it as an "atmosphere that makes it easy to express opinions". Almost 99% replied that "the decisions taken in the nurse administrators' meeting should be communicated to the staff" and 51.7% replied that they would not speak much about the meetings' decisions. More than 78% of the nurse managers had a meeting experience that was difficult to communicate with others. Over 82% of nurse managers were satisfied with the decisions of the meeting and 97.5% informed about their intention to practice. The average participation rate score of the group who replied positively for "experience to say their opinion" was 2.88 points higher than the group replied negatively (t=13.34, p<.001). Recognitions such as "a place for exchanging opinions", "speech is well-received by the director of nursing", and "speech is well-received by nurses" were associated with "decision convenience" (P<.001).

【Aim】To classify nurses according to the score patterns of positive and negative experiences during hospital organizational change and investigate their different characteristics based on their classifications.

【Methods】Questionnaire survey was conducted with nurses from June to September 2017 in the wards that had been restructured in the past two years. The survey employed the Perceived Ability Development scale, New Brief Job Stress Questionnaire, Three-Dimensional Organizational Commitment Scale, Organizational Justice Scale, and Managers' Support Scale. Nurses' classification was performed using a cluster analysis based on scale scores to determine their level of experiences during hospital organizational change. Moreover, their characteristics with regards to their classifications were compared using chi‐square test or Kruskal-Wallis test.

【Results】Data from 1989 participants representing 65.6% of nurses in 80 hospitals were analyzed. The participants were classified into 623 nurses in high positive/high negative experiences (HP/HN), 613 nurses in middle positive/low negative experiences (MP/LN), and 753 nurses in low positive/high negative experiences (LP/HN). Nurses in HP/HN had longer years of nursing experience. There were many assistant managers in HP/HN, whereas LP/HN comprised mostly staff. Those in LP/HN had lower score of organizational commitment, organizational state, and management state than the others.

【Discussion】The relationship between positive experience and negative experience was not contrasting; one did not become stronger when the other became weaker. Moreover, nurses' classifications could predict their organizational commitment and could be influenced by the organizational state and management state.

This study aimed to develop a scale measuring everyday behaviors of nurses who practice Partnership Nursing System (PNS: two nurses partnering to provide primary care for patients) based on the practices of the hospital where PNS was developed. The participants were 612 nurses working at institutions across Japan in which PNS was introduced. Of questionnaires returned, we analyzed 355 responses from nurses who had partners throughout the year and experience as a ward leader. Factor analysis yielded four factors and 15 items: information sharing behaviors between a pair of nurses (5 items); PNS complementary system behaviors within routine work (4 items); PNS complementary system behaviors between partners and groups (3 items); and leader behaviors (3 items). For criterion-related validity, a significance level of 1% was confirmed between this scale and the Nursing Partnership Scale (r=0.585) and Nursing Teamwork Measurement Scale (r=0.555). For reliability, Cronbach's alpha coefficients were 0.7 or more for each factor and the entire scale. For test-retest reliability, a significance level of 1% was confirmed for each factor score and the total scale scores. Regarding construct validity, differences in mean scale scores were tested; a significance level of 1% was found between those who had partners throughout the year and those who did not; and between those with more than three years and those with less than three years of PNS experience. These results suggest that the PNS Behavior Measurement Scale has sufficient reliability and validity.

We aimed to study how differences in the career design affect psychological empowerment in mid-career nurses with empowerment structure access. The study participants included 216 nurses who were working for the past 5–15 years at 7 hospitals in the capital area of Japan. The data were collected via anonymous self-administered questionnaire, including questions on basic attributes, Conditions of Work Effectiveness Questionnaire-Ⅱ, Psychological Empowerment Scale , and Career Design Scale for nurses. A two-way ANOVA using dependent variable psychological empowerment and independent variables empowerment structure access and career design and its components was performed. Consequently, the main effects observed were related to empowerment structure access (F(1, 212)=7.51, p<.01) and career design (F(1, 212)=29.00, p<.001); psychological empowerment of the high group of each independent was greater than that of the low group. Furthermore, interaction was observed between empowerment structure access and crossroad awareness of nurse life in the carrier design components (F(1, 212)=7.85, p<.001). These show that empowerment structure access and the difference in the degree of career design affect psychological empowerment for mid-career nurses. In addition, it was confirmed that nurses who accessed empowerment structures affects psychological empowerment via "crossroad awareness of nurse life", but issues remain in factor reliability. Therefore, further study is necessary in the future.

Purpose: This study aimed to clarify the perceptions of hand hygiene's importance for clinical nurses and determine training needs without overburdening

Method: Semi-structured interviews performed with ten nurses working at a critical care hospital with at least three years of work experience. Qualitative analysis was conducted with the results.

Result: We categorized four types of responses. First: Nurses felt encouraged by their colleagues. Some said, "I've learned hand hygiene by watching others," or "I don't want to cause infection," or "I don't want others to think I don't sanitize my hands." Some said, "I practice it because others watch me," while some said, "I habitually do it." Two: When nurses want to protect themselves, they habitually do it. Some nurses said, "clinical practitioners and patients have different responsibilities," and "human waste is unsanitary," making them aware they "might be contaminated." Three: When nurses learned about hand hygiene from experience. Some nurses said, "It would be troublesome if an infection occurs" and "I can imagine the path of infection," making them believe, "hand hygiene is necessary." Inversely, some said, "Hand hygiene doesn't always cause infections." Four: When nurses had no time to think about hand hygiene. Some said, "I want to work without interruptions," or "no one can practice perfect hand hygiene" or "I don't always think about it." Others said, "it is impossible with the time I have," or "it never crossed my mind."

Discussion: To incorporate hand hygiene into clinical nursing practice, it is important to consider these perceptions.

Objective: This study describes nursing practices for older adults when clinical pathways are adopted in gastroenterological surgery wards.

Method: Semi-structured interviews were conducted with nine nurses with a clinical experience of five years or more. Data were examined using qualitative content analysis.

Results: Nurses were aware of the advantages and difficulties of adapting clinical pathways for older adults. Nursing practices were grouped into four categories. Of these, two categories pertained to nursing practices considering the characteristics of older adults when using clinical pathways, i.e.,: (1) providing older adults with nursing care by emphasizing on clinical judgment based on clinical experience, regardless of clinical pathways, and (2) recognizing the need for executing appropriate discharge planning for older adults. The other two categories pertained to difficulties experienced during nursing practice with older adults, i.e.,: (3) lack of confidence in caring for older adults, and (4) not considering the characteristics of older adults.

Discussion: Some nurses experienced difficulties in adapting the clinical pathway to needs for older, frail adults. These results suggest that clinical pathways for adults are ineffective for older, frail adults. Some nurses provided geriatric nursing practices regardless of clinical pathways; these practices should be disseminated to other nurses.

Conclusion: It is necessary to develop clinical pathways considering older adults' characteristics and to educate nurses to improve their geriatric nursing practice abilities in acute care hospitals.

The purpose of this research is to clarify the thoughts and roles of the head nurses at hospitals, four months after the Kumamoto Earthquake, and to also acquire suggestions to provide support for head nurses. A semi-structured survey was carried out on 5 head nurses, then analyzed qualitatively and inductively. This resulted in 29 subcategories from 188 codes. 9 categories were extracted; pain of working while afflicted by disaster, self-realization as a municipal employee and concern about limitations, efforts as head nurse towards nurses after earthquake, expectations and worries towards reconstruction, hesitation to act as head nurse from experiencing earthquake, realization of future disaster preparation measures, transition work to fulfill role as head nurse, feeling grief as head nurse due to empty time waiting for hospital reconstruction, and wanting a liberally strong message from the Nursing department due to the chaotic period after the earthquake.

The 4-month period after the earthquake was a time of transition while dealing with concerns, despair and a desire to move forward. Head nurses carried many roles but felt as they didn't fulfill them. The Nursing department may need to provide opportunities for head nurses to express their feelings, take approaches to positively grasp the experience of disasters, and provide training not only to improve disaster preparation measures during ordinary times, but also to increase education to enhance roles and resilience as nurses.

[Objective] The purpose of this study was to establish a scale for the extent of participation in hospital management by nurses employed at municipal DPC hospitals and to evaluate the reliability and validity of the scale.

[Method] This survey was conducted with 1419 nurses from four institutions. The extent of participation in hospital management by nurses was analyzed by an investigation of the survey items followed by exploratory factor analysis and confirmatory factor analysis. A multiple regression analysis was performed with the basic attributes and the values in the work of nurses and level of satisfaction by Nakayama (2001) as related factors.

[Result] There were 579 effective responses (40.8%) in this survey. The extent of participation in hospital management by nurses constituted 24 items of the seven factors, which were understanding the management index of the institution, understanding the financial circumstances and medical fee system, awareness of the contribution as a member of the organization, motivation for learning about hospital management, cost-conscious efforts, involvement in the organizational target, and effort for higher work efficiency. The reliability coefficient α was 0.853, and the suitability of the model was GFI=0.890, AGFI=0.865, RMSEA=0.065. Also, the extent of participation in hospital management by nurses was significantly related to the factors of self-fulfillment as a nurse.

[Conclusion] The extent of participation in hospital management by nurses constituted 24 items of the seven factors with confirmed reliability and validity.

The purpose of the present study was to clarify the effects of nurse rotation on the career development of nurses and the determination and support of nursing department directors for rotation that leads to career development. Semi-structured interviews were conducted with 10 nursing department directors at 10 public hospitals and the results were qualitatively analyzed. Nursing department directors considered the following effects of rotation, classified into 11 categories, as influencing the career development of nurses: "Improvement of ability to form human relationships" "Improvement of nursing practice ability" "Improvement of problem-solving ability" "Growth by acquiring the power for self-change" "Growth by overcoming difficulties" "Growth by establishing oneself through organizational socialization" "Acquisition of new career direction" "Discovery of self-image" "Continuation of work made possible by maintaining work-life balance" "Psychological depression due to negative emotions" and "Crisis of interruption of career" Regarding how determination for rotation by nursing department directors leads to the career development of nurses, the following three categories were identified: "Reflection of career needs on rotation" "Selection of departments to support career development" and "Selection of departments in line with life events" Furthermore, the following three categories regarding support before and after rotation were identified: "Support through dialogue to accept the rotation" "Encouragement of organizational socialization in new departments" and "Encouragement of overcoming difficulties" The determination and support of the nursing department directors are important for rotations to lead to career development.

Purpose: The purposes of this study were to clarify the competency of nurses in supporting a transition to home care in an integrated community care system, develop a scale to measure that competency, and test its reliability and validity.

Methods: An interview survey was conducted on the competency of nurses who make hospital to home care transitions possible. The results were integrated with the results of a literature review on hospital discharge support, and draft questions were prepared. The questions were then examined by an expert panel and the questionnaire was completed through a pilot study. A survey of 1,348 nurses nationwide was conducted using this questionnaire. To assess the questionnaire's reliability, Cronbach's α coefficient was calculated and a test-retest method was implemented. To assess its validity, concurrent validity was examined by calculating the correlation coefficient with the Nurses' Discharge Planning Ability Scale and construct validity was examined from the results of factor analysis.

Results: An analysis was done using 614 valid responses (45.5%) from the national survey. This scale was created with 35 items and 4 factors: Factor 1, "Optimization for the hospital to home transition"; Factor 2, "Coordination with the patient and family as the principal axis"; Factor 3, "Specialized assessment and practices that respect the values of the patient and family"; and Factor 4, "Planning in order to achieve targets." Cronbach's α coefficient for the scale overall was 0.963, and the correlation of the test-retest method was r = 0.682. The correlation with the Nurses' Discharge Planning Ability Scale was r = 0.768. The status of agreement between the extracted factors and the construct of the draft questionnaire, and the structure of each factor, were confirmed.

Conclusion: This scale consists of 4 factors and 35 items, and its reliability and validity were confirmed.

The purpose of this study was to verify the sustained effect of the collaborative quality improvement for neonatal pain management on neonatal intensive care units (NICUs) by comparing the rate of the implementation rates of the quality indicators (QI) of neonatal pain in NICU between attending first time group (FG, n=5) and attending twice group (TG, n=3). We used the Jonckheere's trend test or Cochran-Armitage test to examine the changes in QI implementation among both groups over time (ie, at baseline, 3months, 6months, 9months, 12months), three QIs were significant in the FG and one QI was significant in the TG. At 12 months, the number of QIs which were over 85% of the implementation rate was 10 items in the TG, but same one was one item in the FG. The baseline pain management data from the TG revealed the all NICU in the group had introduced pain assessment tools, and developed electronic medical record forms to capture pain score, interventions, and reassessment infant pain. While only two NICUs among the FG had introduce pain assessment tool, no units had developed electronic medical records regarding pain management. This study showed the effect of the collaborative quality improvement for neonatal pain maintained among the NICUs attending second through non-participating period.

Purpose: This study aimed to validate content validity of the Evaluation List of competencies with Rehabilitation Nursing.

Method: A cross-sectional survey was conducted using an anonymous self-reporting questionnaire. Questions concerned demographics, the Evaluation List of Competency with Rehabilitation Nursing with 80 behavioral characteristics of 10 competences, and a shortened version of the Social Skill Scale for Nursing with four subscales. The wording of the questions related to the 80 behavioral characteristics was revised in a preliminary survey and the main survey was distributed to 1,016 nurses who worked in recovery rehabilitation wards at 22 randomly selected hospitals throughout Japan. Competence scores were calculated from the Evaluation List of competencies with Rehabilitation Nursing. Tests of differences between basic demographic data and correlations with social skills in nursing scores were verified to determine competence scores.

Results & Discussion: We obtained 555 valid responses from the nurses. All competence scores for years of experience in recovery rehabilitation wards, position and qualifications significantly differed among the nurses (p=0.005~<0.001). Correlations between scores for competence and for the four subscales of social skills in nursing were more than moderately positive (r=0.37~0.67, p<0.001).

Conclusion: Statistical verification confirmed the content validity of the Evaluation List of Competency with Rehabilitation Nursing.

This study aimed to develop a scale for assessing the role behaviors of nurse managers in postgraduate education for newly-graduated nurses and investigate its reliability and validity. An initial scale composed of 37 items was developed based on published papers. An anonymous questionnaire was administered to nurse managers (N=107) who worked at university or general hospitals with over 500 beds in the Chugoku and Shikoku regions and were accepting newly-graduated nurses in his/her ward. Principal factor analysis (promax rotation) was performed to verify the construct validity, determine the factor structure, and compare the factor structure with the initial structure set. The following six factors (comprising 23 items; cumulative contribution ratio, 57.5%) of role behaviors of nurse managers for newly-graduated nurses were identified: "maintenance of an educational system"; "mental health support"; "support for developing as a nurse"; "support for gaining confidence"; "fostering of work environment"; and "instructor selection". Regarding reliability, Cronbach's alpha was 0.84 for the entire scale, and ranged from 0.79 to 0.84 for each factor, which demonstrates internal consistency. Significant positive correlations were observed between each factor on this scale and the Role Behavior of Nurse Managers in Preceptorships scale (r=0.26~0.67, p<0.001), except for 3 factors that did not show correlations with "instructor selection" (r=0.13~0.16). The initial construct concepts were mostly consistent with the factors of the created scale, needed to be reinforced construct validity.

Purpose: This study aimed to clarify the competencies of nurses employed in elderly nursing homes.

Method: Behavioral Event Interviewing was conducted with 12 nurses who had been working for over three years in an elderly nursing home. Data were analyzed using a qualitative descriptive approach.

Results: A total of 131 nursing behaviors were obtained. After abstraction, the following 6 competencies were identified: ‘Supporting living while respecting the values of elderly people'; ‘To fully understand the mental and physical condition of the elderly people and to link it to care'; ‘Supporting families in consideration of their feelings'; ‘Being satisfied with performing end of life care for the residents and their families'; ‘Growing with care workers'; and ‘Exercising leadership both inside and outside the facility'.

Conclusion: The present study clarified the competencies of nurses employed in elderly nursing homes. Furthermore, the levels of difficulty should be statistically verified in a future study

Objective: To determine the association between advice-seeking activities by novice and second-year nurses at hospital wards and the following factors: relationship with nurses in the same ward, Ibasho (sense of authenticity and self-usefulness), and self-efficacy.

Method: Anonymous self-reported questionnaires were distributed to 250 novice nurses and 257 second-year nurses from four acute care hospitals between June and August, 2016. The questionnaire enquired about advice-seeking activities at hospital wards, relationships with nurses in the same ward (social support and negative reactions), Ibasho, self-efficacy, and personal attributes. Questions about advice-seeking activities were based on four hypothetical situations: 1. changes to a patient's drainage, 2. anxiety due to uncertainty about a patient's care, 3. changes in a patient's mood (unusual behaviors or conversations), and 4. making suggestions for patient care. Structural equation modeling (SEM) was used to determine the factors affecting advice-seeking activities in these situations.

Results: A total of 181 responses were collected (response rate, 35.7%). Valid responses from 94 novice nurses and 86 second-year nurses were used. No models were obtained by SEM for any of the four situations among novice nurses, or for situations 1, 2, and 3 among second-year nurses. The model for situation 4 among second-year nurses (n = 65) showed that emotional support from senior nurses and peers with the same number of years of experience and self-efficacy affected advice-seeking activities through Ibasho (GFI = .958, AGFI = .902, RMSER = .000).

Conclusion: Emotional support from peers and self-efficacy affected advice-seeking activities through Ibasho, among second-year nurses.

An online survey was conducted from January to February 2020 to study the working conditions of shift-working nurses, their willingness to continue working under their current work conditions, the conditions under which they were willing to continue shift work, to provide materials for the estimation of nursing personnel demand, and to aid in considering measures for securing shift-working nurses. Participation requests were sent to 4,601 nurses at 47 hospitals. Participants were questioned about the last shift or last month they worked. Excluding new nurses, 394 of 410 responses were analyzed. The analysis revealed on average, a shift schedule consisted of 9–10 days off and 7–8 night shifts. Most two-shift nurses had night shifts that lasted longer than 13 hours. Three-shift nurses never had night shifts that extended past 13 hours; but, they were more likely to work at intervals of <11 hours, for more than six days consecutively, and get insufficient rest after night shifts. They were also less satisfied with their schedules than two-shift nurses. Approximately 40% of the participants reported their unwillingness to continue working under their current work conditions and >50% indicated their inability to continue working for longer than three years. Three-shift nurses responded that they needed approximately 2.4 more days off per month to rest—more than approximately 1.9 days needed by two-shift nurses. For participants to continue working, they need approximately two additional days off a month and to increase the number of nurses to reduce the need for overtime work.

Purpose: This study aimed to clarify the changes of nursing management rounds by deputy directors of nursing incorporating a "Share Perspectives Meeting".

Methods: Action research incorporating a "Share Perspectives Meeting" comprising one director of nursing and four deputy directors of nursing from one hospital was carried out to analyze the practice of nursing management rounds. In addition, a group interview was conducted with seven nurses on their perceptions about changes in the round.

Results: Seven objects were identified through the "Share Perspectives Meeting". The practice of the rounds consisted of:10 categories of efforts, 13 categories of results, and 8 categories of challenges. The changes of the rounds were shown in four phases indicating the gradual progress of information sharing and problem solving. The perceptions of head nurses consisted of the recognition of the positive impacts of rounds, enhancement of advice, and support as well as issues uncertainty in response to rounds that do not meet expectations.

Discussion: This study suggests that the incorporation of the "Share Perspectives Meeting" promotes the expansion of the viewpoint of the round and the work to visualize the results, and brings about a change in the round.

However, to encourage greater infiltration of efforts, the possibility of rounds carried out by teams including head nurses should be explored.

Objectives: This study aims to determine factors related to self-esteem, taking moral sensitivity into account, among psychiatric nurses and examine possible support measures for nurses.

Methods: A questionnaire survey was administered to 122 nurses working in one non-public hospital (valid responses, 61.00%), covering demographics, working environment factors, the experience of negative feelings toward patients (Matsuura & Suzuki, 2014), moral sensitivity (Maeda et al., 2019), and self-esteem (Rosenberg, 1965; Yamamoto et al., 1982). Using the total score of the self-esteem scale as the dependent valuable, a hierarchical multiple regression analysis was conducted.

Results: The average age of respondents was 48.16 ±15.24 years , with an average of 23.14±15.21 years of nursing experience. The multiple regression analysis showed 0.68 adjusted coefficient of determination. Factors related to self-esteem among psychiatric nurses included transfer requests, moral sensitivity, length of overtime, the experience of providing care while harboring negative feelings toward patients, persons to consult with about worries at the workplace, and educational background. Among the factors positively correlated to self-esteem, "moral strength", was most influential, but was negatively correlated to "sense of moral burden".

Conclusions: To maintain the self-esteem of nurses, it is supposed to be effective to pay attention not to emphasize "sense of moral burden" in the support for developing "moral strength", in workshops on nursing ethics, and important to support ensuring moderate length of overtime; building a sense of belonging to the workplace and occupational status; opportunities for consultations with superiors; and arranging in-hospital workshops to overcome awareness of disparities due to differences in educational background.

Aim: This study aimed to clarify the implementation of a nursing assessment and the degree to which nurses recognize its importance for cancer patients before their first outpatient chemotherapy, and to verify factors, including workplace environment, related to psychological and social nursing assessment implementation.

Method: A questionnaire was administered to nurses in departments conducting outpatient chemotherapy in 500 randomized metropolitan hospitals. The physical, psychological, and social conditions of patients were compared for implementation of assessment and recognition of importance. Next, a hierarchical multiple regression analysis with psychological and social assessment as dependent variables was conducted.

Result: Of 2500 questionnaires mailed, 317 valid responses from 120 hospitals were returned. The implementation of assessment for psychological and social aspects was significantly lower than for physical aspects. The recognition of its importance for all three aspects was high. The result of the hierarchical multiple regression analysis, found that "Having independent chemotherapy room" and "many years of experience of outpatient chemotherapy" were significantly correlated after controlling for the independent variables of nurse-related and hospital-related factors. When all factors were added to the model, "the high degree of recognition of assessment importance" and "setting time to talk with patients" were significantly correlated. "prepared manual," "having study meeting," "dedicated chemotherapy," were significantly correlated limited to implementation of assessment for social aspects.

Conclusion: Nurse's implemented psychological and social assessments for outpatient chemotherapy significantly less than physical assessments. The implementation rate of nursing assessment can possibly be facilitated by improving the workplace environment.