Objective: To clarify the roles of and challenges faced by charge nurses in improving the quality of nursing at acute hospitals.

Method: A qualitative study was conducted using semi-structured interviews to ascertain the roles of charge nurses and the challenges that arise in executing these roles. Focus group interviews were conducted with 4–6 charge nurses with at least 5 years' experience as a charge nurse from 10 different acute hospitals charging a basic hospitalization fee for a patient-to-nurse ratio of 7:1, and with 300 or more beds in 3 prefectures in the Chugoku region of Japan. Narratives were created from the data obtained and parts related to the roles and challenges in role execution of charge nurses were extracted and subject to qualitative descriptive analysis.

Results: Forty-seven charge nurses from 10 hospitals were subject to analysis. The roles of charge nurses were classified into 7 categories: "collaboration with the nurse manager," "staff empowerment," "activities with the objective of healthcare safety," "establishing mechanisms for improving operations," "coordination with a broad range of people," "action with a focus on hospital management," and "personal development as a charge nurse." Two categories were extracted as the challenges faced in performing these roles: "administrators' personal experience with lack of competence" and "uncertainty regarding career development."

Discussion: The charge nurse at an acute-care hospital assumes a wide variety of roles. These include implementing management in collaboration with the nurse manager that is focused on hospital management in an era of healthcare reform based on the nurse manager's vision for improving nursing care, and personnel development aimed at increasing department expertise and providing high-quality care. The charge nurse faces a dilemma between recognizing the need to improve their ability in assuming and actually performing these roles, and this gives rise to uncertainty regarding career development.

This ethnographic study aims to describe how nurses delegate hygiene care to nursing assistants at general wards in acute care hospitals. Participant observations and semi-structured interviews were conducted in a ward of two facilities for approximately three months involving two head nurses, eight nurses with five years experience or more and six assistants. Eight often observed common interactions included: 1. Nurses perceived hygiene care as essential nursing work and only requested help from assistants when the workload was too much for them. 2. Nurses were prepared to take full responsibility for the tasks they delegated to assure the safety of patients and assistants. 3. Nurses identified what could be delegated to assistants who didn't have medical qualifications. 4. Nurses, keeping in mind not to give excessive work, delegated so the assistants could easily carry out their duties. 5. Considering the background of each assistant, nurses succinctly communicated with the assistants what they were delegated to do to facilitate their understanding. 6. For safety, nurses and assistants shared necessary information in advance. 7. Nurses performed observation and treatment during hygiene care to reduce the burden on the patient. 8. Hygiene care jointly performed by a nurse and an assistant progressed smoothly without exchanging words. Interactions specific to ward A were that assistants performed hygiene care based on their judgement to help busy nurses, while in ward B, delegation from a lead nurse, who only thinks about optimal hygiene care for the patient, to an assistant, who didn't follow instructions, created difficulties.

Aim: Community healthcare is being promoted as a medical care delivery system for a super-aging society. To ensure the quality and quantity of home nursing, the use of certified nurse specialists (CNSs) and certified nurses (CNs) working in hospitals has been attracting attention as a potential countermeasure. This study aimed to clarify the factors associated with nursing practices in support of home nursing.

Methods: An anonymous self-administered questionnaire was conducted among 216 CNSs and CNs working at hospitals in Japan's A prefecture. The survey included home nursing support activities (direct care, consultation, discharge support, and education and research), the consultation network, an evaluation of the environment, and the respondents' primary attributes. A multiple logistic regression analysis was performed, with home nursing support activities as the dependent variable.

Results: The data from 130 respondents were analyzed. Engagements in direct care was low (25.4%) and consultations were most common (76.9%). By discipline, "CNs in Wound, Ostomy and Continence Nursing" were more likely to practice all the investigated activities. The number of outside-hospital healthcare professionals consulted by the CNSs/CNs was significant across all four categories (OR: 1.29–1.87). In addition, "the recognition of their own role in home nursing" and "the experience of participating in community care conferences" were significant for the categories of "direct care" and "education and research."

Conclusion: For CNSs/CNs to promote support activities, their networks with specialists outside the hospital should be expanded and they must be aware that they can use their expertise at home.

Objective: The purpose of this study was to clarify the factors affecting Work engagement in staff nurses.

Method: In total, 535 nurses at two general hospitals completed self-administered anonymized questionnaires. The questionnaire assessed their personal background and employment status, and incorporated the Japanese Short version of the Utrecht Work Engagement Scale, Adolescent Resilience Scale, and New Brief Job Stress Questionnaire. A stepwise multiple regression analysis was conducted with work engagement as the dependent variable.

Results: Results were collected from 317 respondents (59.25% collection rate), and 269 valid responses were obtained (84.86% valid response rate). Resilience (β=.298, p<.001), age as included in personal background (β=.225, p<.001), job significance as included in job resources (β=.214, p < .001), job aptitude (β=.109, p<.05), and work-self balance (positive) (β=.280, p<.001) impacted nurses' Work engagement.

Discussion: Leveraging the resilience, feeling the significance of work, feeling the positive view of work, and the aptitude to work, may lead to cheerful and active work style among nurses.

It is necessary to create an environment in which the meaning of work can be verbalized and to provide support so that people can view their own work positively.

This study aimed to tailor the Sense of Coherence Scale (SOC) for nursing organizations and confirm its reliability and validity. A total of 3, 316 nurses from eight hospitals (approximately 300–900 beds) in a metropolitan area were surveyed using a self-administered questionnaire to collect data on basic characteristics (e.g., age, sex, and years of nursing experience), nursing organization SOC, and work satisfaction and Work-SOC as criterion variables. The number of nurses who consented to participate in the study and returned the questionnaire was 2, 054 (recovery rate, 61.9%), with 1, 933 responses found to be valid (valid response rate, 58.3%) and consequently eligible for analysis. The respondents had a mean age of 33.0±9.7 years, were predominantly female (89.9%), and on average had 9.9±9.0 years of nursing experience, while the mean number of years working in a particular department was 3.6±3.2 years. The Item-Total correlation of the 16-item SOC was found to be 0.50 or more for all items, and Cronbach's alpha for the whole scale was 0.912. Covariance structure analysis showed that the comparative fit index and RSMEA of the 16-item SOC, whose error variance was modified based on a modification index, were 0.915 and 0.077, respectively. The 16-item SOC was significantly positively correlated with work satisfaction (criterion variables) (r=0.451, p<0.001) and Work-SOC (r=0.638, p<0.001). Accordingly, the reliability, concurrent validity, and convergent validity of the 16-item SOC with modified error variance for nursing organizations were confirmed.

Objective: This study aimed to develop a scale to assess the role behavior of chief nurses who support the families of patients with life-threatening conditions and nurses and verify the reliability and validity of the scale.

Methods: A preliminary scale was developed based on previous studies and clinical experiences. Experts analyzed the questions on the scale to assess their internal validity. An anonymous self-administered questionnaire comprising 81 items assessed on the 5-point scale was mailed to 568 chief nurses working in acute general wards. Analyses of the following were performed: scale items, exploratory factors, Cronbach's alpha, and correlation with external criteria.

Results: The valid response rate was 40.4% (230 nurses). Exploratory factor analysis using the maximum likelihood method and Promax rotation identified 4 factors and 44 items: "approval and assurance for nurses who support families in crisis;" "creating a stable environment for families in crisis, in which their needs can be understood, and purposeful interaction;" "creating opportunities for, and being solicitous in, securing time and space for families;" and "bridging between families in crisis and the medical team." Cronbach's alpha for each factor ranged from 0.884 to 0.921. The coefficient of correlation with external criteria ranged from 0.398 to 0.662. A significant correlation was noted with a significance level of 0.01.

Conclusion: The study verified that the developed scale was reliable and valid.

Objectives: This study aimed to identify occupational identity as a nurse, resilience, and ego identity among nurses under three years of experience, as well as the relationship between these variables and quality of occupational experience.

Methods: The study participants were 950 nurses with less than three years of experience working across 39 hospitals and had obtained the permission of the nursing manager to participate in this study. The data were collected through anonymous self-administered questionnaires that included questions on basic attributes, Scale of Occupational Experiences for Nurses (OEN), Multidimensional Ego Identity Scale (MEIS), Professional Identity Scale for Nurses (PISN), Bidimensional Resilience Scale (BRS). The questionnaire response rate was 35.9%, with 312valid responses (32.8%). Data were analyzed using Pearson's correlation coefficient analysis and Multiple linear regression analysis.

Results: A significant correlation was observed between OEN and PISN (r=0.565, p<.01), as well as PISN and BRS (r=0.551, p<.01). Both PISN (β=.432, p<.001) and BRS (β=.219, p<.001) were significant predictors of OEN. Additionally, a sense of oneness-continuity of ego was negatively effected by [Experiences in coping with the achievement of the developmental task and occupational experience] (β=-.239, p=.005), and [Experiences of maintaining employment, worrying and wavering] (β=-.272, p=.001).

Conclusion: This study revealed that enhancing professional identity as nurses and acquiring resilience were critical in improving the quality of occupational experience. Furthermore, the conflict between ego identity and identity as nurses may influence the quality of occupational experiences.

Purpose: This study aimed to identify the competencies required for nurses to contribute to the integrated community care system.

Method: The target facilities were nursing homes, hospital discharge support departments, and visiting nurses. Our participants included nurses with more than 10 years experience. We conducted an interview survey among 10 respondents and then performed a qualitative inductive analysis.

Result: Thirty categories of competencies required by nurses for effectively contributing to the integrated community care system were extracted. The following competencies were identified: "multi-professional cooperation," "awareness of role as a nurse in integrated community care," "nursing provision from the perspective of daily activities and health management," "end-of-life care," "relationship with caregivers," "cooperation between nurses," "communication," "assessment," "leadership," "dementia care," "management and transition support," "implementation of agreement formation," and "human resources development." In future, it will be necessary to expand on the target population used in this study for greater generalization that would allow for the creation of educational programs for nurses that would assist them in effectively contributing to a given comprehensive community care system.

The purpose of this study is to clarify the time when new graduate nurses are independence of night shift work, and the ability of new graduate nurses to practice nursing during the time when they are independence, and the relationship between the time when new graduate nurses are independence of night shift work, and the ward guidance system for new graduate nursing. A questionnaire survey of 614 new graduate nurses working and 198 head nurses in 20 hospitals was surveyed. The contents of the survey are the time of independence of night shift work, the individual attributes and nursing practice ability of new graduate nurses, and the structure index and process index of the ward. In the analysis, the time of independence of night shift work was converted into days, and the median was divided into the early group and the late group. The Mann-Whitney U test and χ² test were performed between the two groups, for individual attributes, nursing practice ability during independence of night shift work, and ward structure and process indicators. As a result, the independence of night shift work of a new graduate nurse in an acute care hospital was from September to October. The new graduate nurse was judged to be independence of night shift work after acquiring the nursing practical ability necessary for night shift work. There are six competencies in nursing practice ability required for independence of night shift work: basic responsibilities, ethical practice, risk management, clinical judgment, planned development of nursing, and supportive human relationships. Suggested that the frequency of implementation had reached a "mostly done" state.

Purpose: This study aims to develop a "Fall risk assessment tool and preventive measures", which will be effective for patients with neurological disorders, and statistically establish the validity of the items included.

Methods: Subjects were 1,002 cases in total of 366 inpatients of hospitals specializing in neurological diseases. Their fall risks were assessed by nurses of the hospital using a draft assessment tool. We had fifteen nurses complete a questionnaire about the usability of the assessment tool. In the analysis, we calculated the odds ratio for the items of the tool for two groups: with and without falls, and carefully selected items by considering the clinical significance reported in the questionnaires.

Results: Based on the statistical verification of the assessment tool and the survey results, we excluded one item with a low odds ratio, "Taking sleeping pills/tranquilizers", and added one item with a statistically significant difference in the univariate analysis, "Memory disorder". As a result, we completed a seven-item fall risk assessment tool, covering "Experience of falls", "Gait disturbance", "vertigo/standing dizziness", "Unable to activate the nurse call button", "Wandering/hyperactivity", "Intuition of nurses", and "Memory disorders". The sensitivity, specificity, and Area Under the Curve (AUC) of the assessment tool were 87.5%, 34.3%, and 0.768, respectively.

Discussion: The findings show that the assessment tool developed here has a similar level of predictive accuracy as existing tools. It is however considered that inclusion of clinical concerns has made the assessment tool easier to use in clinical settings.

Purpose: The purpose of this study was to hold "dialogue meetings" between assistant head nurses and researchers. The study aimed to examine what role "dialogue meetings" played for assistant head nurses in facilitating changes in perceptions and behaviors related to human resource development.

Method: Qualitative descriptive research was conducted using the action research method. The action was for the assistant head nurses and the researcher to hold dialogue meetings. A total of 11 participants were included in the study, with three assistant head nurses participating in the dialogue meetings and eight nurses or deputy nursing director participating in only the interviews. Overall, five meetings were conducted.

Results: In the "dialogue meetings," case examples were presented using case sheets, and the researcher and participants talked freely based on the case examples. The assistant head nurses who participated in the "dialogue meetings" exhibited changes in their perceptions and behaviors related to human resource development. The assistant head who participated only in the interviews also reported changes in their perceptions of human resource development.

Discussion: The meetings were a space for self-reflection where assistant head nurses could talk about their understanding of their role. They could also reflect on their thoughts and purpose in relation to the perspectives of others. The results suggest that by having assistant head nurses in the similar roles engage in dialogues during the "dialogue meetings," they gained awareness and practical knowledge. As a result, changes occurred in their perceptions and behaviors related to human resource development.

This study systematically reviews the nursing practice ability and clarifies the abilities required for nursing amidst the changing times. We aimed to obtain educational material for improving nursing skills. We searched peer-reviewed journals on the CINAHL, Medline, and ICHUSHI databases, using the keywords "nursing practice," "professional ability," and "nurse" and extracted 45 papers concerning the ability of nurses to practice nursing. We organized the names and definitions of these abilities and grouped them according to the similarity and differences in skills. Consequently, various nursing practice concepts emerged. Nursing practice ability was narrowly defined as "the ability to practice and provide nursing to patients," and broadly defined as one that is "conscious of the role in working in an organization and team as a nursing profession." Furthermore, six skills were identified as the components of nursing practice ability, namely, technical skills, situation judgment skills, role performance skills, autonomy skills, problem-solving skills, and interpersonal skills. The target literature suggests that in order to provide high-quality nursing, it is necessary to have the ability to practice it while being aware of one's role in the organization or team in response to the changing times. We recognize the need to unify the definition of nursing practice ability in the future. Nursing professionals also need to strengthen learning as a profession in basic nursing and continuing education, organizations, and societies for the coming era. It was suggested that educational support, such as workshops for learning "judgment," "role performance," "autonomy," and "problem solving," is necessary.

The purpose of this study was to clarify the personal factors that cause nurses to remain in their profession. We conducted semi-structured interviews with 17 Mid-level nurses with more than five years of clinical experience who we qualitatively analyzed at hospitals and home-visit nursing stations. We determined four personal factors that explain why Mid-level nurses remain in their profession: the attraction, importance, and suitability for the profession and interpersonal skills in the workplace. These factors interact with the "willingness" and "behavior to continue nursing" which are interpreted as a "state of continuing nursing" that could affect society. This may be explained by the self-efficacy of learning theory, and it was suggested that these four factors should be properly supported and self-efficacy increased in order to continue the nursing profession.

The purpose of this study was to determine the extent of learning through in-hospital education of nurses as well as the influences of the organizational environment and individual factors on this learning. The study participants were 1,185 nurses working at hospitals in two adjacent prefectures. To recruit the participants, 2,777 questionnaires were delivered to nurses and a total of 1,243 nurses responded. A self-administered questionnaire survey was sent in the mail. In addition to the basic attributes of participants, the survey items included organizational environmental factors such as the number of beds in the facility where they were currently working, the presence or absence of mentors or models, and the presence or absence of leadership role experience. Additional survey items were related to career self-reliance and learning through in-hospital education among nurses. A hierarchical multiple regression analysis, where learning through in-hospital education among nurses was set as the dependent variable, was used. Of the five subfactors of "learning scale on in-hospital education for nurses," "acquisition of basic nursing" exhibited the highest average value, and "self-growth as a person" exhibited the lowest average value. Results of the hierarchical multiple regression analysis revealed that the factors related to learning through in-hospital education among nurses included nurse age, clinical experience, number of facility beds, presence of mentors or models, leadership role experience and career self-reliance. These results suggest that an organizational environment that is conducive to learning and a strong willingness to learn may promote the extent that nurses learn through in-hospital education.

This study aimed to identify the experiences of nurses working in the outpatient chemotherapy unit using a descriptive approach. An unstructured interview was conducted involving two nurses working in the outpatient chemotherapy unit of a general hospital. By focusing on the narratives of each nurse to describe their experiences, this study explored how their experiences contribute to the setting of the outpatient chemotherapy unit, what is the spiritual base nature of nursing born from each nurse's experience, and how the experience of working in the outpatient chemotherapy unit is positioned in their own career, using phenomenological attitudes as a guide.

As the results, the nurses considered the outpatient chemotherapy unit as a place where they could "spend a great deal of time with patients" and "communicate well with them", and such practice was supported by the unique environment of the unit, where nurses interact with individual patients over a long period of time. The experiences of each nurse reflected the spiritual base of nursing, "wishing to help patients who are struggling" and "exploring ways to support lives of patients with cancer". Also, while being assigned to the outpatient chemotherapy unit and continuing to work there, each nurse considered job rotations and involvement with patients as turning points, and on each such occasion accumulated "major maturing experiences." The stories told by each nurse gave meaning to these "major maturing experiences," leading them to realize their own value as a nurse, which helped them to overcome career problems and grow.

Objective: The aim of this study was to describe the professional attitudes and knowledge of nurse managers and the organizational changes that ensued after their participation in an "educational program using a Competency Model for Nurse Managers." An additional objective was to identify how nurse managers understood competency.

Methods: We conducted focus group interviews with 15 nurse managers from two hospitals that had implemented the aforementioned program. The program consisted of six clusters and 16 competencies with six levels. We performed a content analysis with an inductive approach to data.

Results: We identified four categories of changes perceived by nurse managers. These included "self-control and getting the bigger picture," "gaining confidence," "realization of the department they wanted to create," and "setting the same vision among themselves." Two additional categories were identified in the process of understanding competency: "overcoming difficulties in describing cases and deeply understanding the concept of competency" and "internalizing and mastering competency."

Conclusion: The findings of this study suggest that this program could lead to changes in an organization as a whole and not only in the practices of nurse managers. Furthermore, descriptions of their own nursing management practices may lead to nursing managers' deepened understanding of the competency.

Aim: To investigate the moral dilemmas faced by nurses working in hospitals specializing in psychiatry (psychiatric hospitals), and clarify the relationship between such dilemmas and mental stress.

Methods: An anonymous self-administered questionnaire survey was conducted in July 2019, involving 486 nurses from 6 psychiatric hospitals (psychiatric nurses), and 418 valid responses were analyzed. To measure moral dilemmas in the psychiatric nurses, an index, adopting a facet design and consisting of three facets: "clinical settings", "moral value of Nurse X", and "people other than with Nurse X", was constructed. The moral dilemma stressor score was calculated by multiplying the mean degree of psychological burden of each item and the case frequency, and the internal consistency and the goodness of fit of the model were confirmed. Each item was examined regarding 2 aspects, the frequency and degree of burden. Then, to clarify the association between moral dilemmas and mental stress in 6 clinical settings according to the facet, multiple regression analysis was performed.

Results and Discussion: Multiple regression analysis revealed that moral dilemmas related to "relationships other than patient" in clinical settings are closely associated with mental stress. In order to resolve such dilemmas, it may be necessary to collaborate with other medical staff, and clarify patients' needs in their decision-making process. Our findings suggest the necessity of fostering an organizational culture in which people can speak out without barriers to the moral dilemmas.

While many head nurses conduct patient rounds as part of their duties, only 23% of hospitals in Japan have guidelines for patient rounds. The purpose of this study was to clarify both the purpose of patient rounds conducted by head nurses working in acute care hospitals and the application structure of such rounds in nursing management. We conducted semi-structured interviews with 10 head nurses working in acute care hospitals with good ward management and analyzed the findings based on the KJ method. The objectives of patient rounds for nurse managers in acute care hospitals were: "to utilize the results of patient rounds for effective and efficient staff education"; "to actively engage as a head nurse and support staff in providing nursing care"; "to link information gained from the head nurse's intuition and awareness to care and improve satisfaction"; "to evaluate the quality of medical services in their own departments that provide acute care"; to prompt and effective bed control to fulfill the role of an acute care hospital"; and "to add to work motivation as a head nurse." These were the six final labels extracted. Furthermore, we structured the relationship between the final labels to determine how nurse managers utilize patient rounds in nursing management. Using the results of this study as a guide for patient rounds may contribute to good ward management in acute care hospitals.

To efficiently provide high-quality nursing care at a time where patients' needs are becoming more complex, nurses must acquire knowledge and skills in nursing management. Therefore, it is necessary to introduce content on nursing management during basic nursing education. This study aimed to identify which nursing management content should be included in basic nursing education, based on the perceptions of experts including nurse managers and researchers. A Delphi Study was conducted, and data were collected using a Web-based survey. The questionnaire covered 59 topics based on existing curricula and literature and were selected by members of the Education Committee of the Japan Academy of Nursing Administration and Policies (JANAP). A total of 134 directors, auditors, and councilors of JANAP were asked to report the importance of each topic on a 5-point Likert scale. The criteria for including topics were a median higher than 4, an IQR less than 1, and the percentage of items rating 4 or above 75%. After three Delphi rounds, 32 topics of learning content were selected. These included management skills and the professionalism with which new graduate nurses should provide care for patients. It would be necessary to discuss the continuity of nursing management education from students to new graduate nurses.

The objective of this study was to clarify the factors related to achievement of goals with adoption of the management-by-objective approach for ward nurses working in acute care hospitals. A self-administered questionnaire survey was conducted of 806 ward nurses (responses of 370 nurses analyzed) from 9 institutions in prefectures A, B, and C. Polynomial logistic regression analysis was performed using the surveyed items pertained to the"achievement of goals," that is, achievement of individual and organizational goals, as a response variable, and the following as explanatory variables: interviewer's position, interview time, etc., and as a goal management timing, "goal setting stage," "task performance stage," "goal evaluation stage," and "overall goal management." The results revealed that relative to the group with "low achievement levels in terms of both individual and organizational goals," the group with "high achievement levels of both individual and organizational goals" showed significantly positive relationships of achievement of goals with "self-control" of "goal setting stage" and "overall goal management".

These findings showed that for the achievement of goals, at the "goal setting stage," which is the first stage of the management-by-objective approach, it is important for the manager to intentionally promote ward nurses to understand the relationship between the organizational and individual goals, so that the ward nurses can act based on their motivation levels toward their work. In addition, these findings suggest the necessity of enabling ward nurses to control themselves, by setting prioritized goals themselves and performing self-evaluation.