Presented at the Japan Academy of Nursing Administration and Policies Fourth Nursing Research Conference on August 25, 2000 in Aomori, Japan, the purpose of the presentation was to review the history, goals, role description, practice outcomes, and current employment of clinical nurse specialists (CNSs) in the US as a basis for consideration of the role of CNSs in the future health care delivery system in Japan.

The study reported here is part of a larger study to develop a method of teaching assertiveness to Japanese nurses. This purpose of this study was to determine content validity of a measurement tool for assertiveness among Japanese nurses. Currently available measurement tools were first examined but did not seem appropriate for the study. As a result the investigators developed their own tool based on the nine individuals rights taught during the assertiveness training session. For each of the nine rights 3 questions were developed to reflect the three communication styles of aggressive, passive and assertive. The questions were based on situations common in the Japanese nursing work place. A likert type scale was used and the questions were randomly arranged. Two expert nurse administrators and one expert nurse researcher examined the instrument for content validity. Further to validate that the questions reflected common working experiences 13 graduate students completed the instrument and provided comments that validated the situations were common in Japanese nursing. The tool was then used pre and post for 32 nurses participating in the assertiveness training workshop. After the completion of the tool post training the nurses discussed the tool and validated that it did reflect common situations and that they could see the styles of communication assertive, aggressive and passive. The results support the content validity of the tool.

The purpose of this study was to contribute that the nurses can take part in and suggest making the policy effectively. In this study, the goal was to clarify who participate in the process of making the policy, how they participate in the process, and what non-personal factors influence the process. The data were collected through literature review; publication archives, Diet and Ministry archives, newspaper et al, and interviews based on a semi-structured questionnaire. Those data were analyzed through content analysis by having the framework. The results were followings:

1) Major participants; Ministry of Health the Welfare, Ministry of Labor, each Political Party, Japanese Nursing Association (JNA), Medical Association, Japanese Medical Labor Union et al.

2) Methods of participating; each participant used different methods, Ministry of Health and Welfare; publication of new policy, negotiation and coordination among the suggestions of participants/Political Party; suggesting of new policy, information exchange with each Ministry and interest groups/JNA; appeal to public opinion, suggesting of new policy, et al.

3) Non-personal factors; publication and change of new policy, change of population composition, media and public opinion, change of working condition et al.

This study describes the support system for the preceptor through the analysis of the preceptorship program. After analyzing 20 general hospitals with more than 300 beds which introduced the system from the late 1980s to the early 1990s, we have got the following results:

1. While every hospital has the instruction system "the training program for preceptors" by the educational division, few has additional instruction system through another program.

2. Head nurses are expected to play the wide range of roles for supporting.

3. The supporting systems are classified into the three following patterns: (1) The supervisor of the preceptor is responsible for making decisions (8 hospitals). (2) The leader of the team is responsible for making decisions (4 hospitals). (3) All members take part in the program (7 hospitals).

These sub-systems are devised according to characteristics and the attitudes for preceptorship of each hospital.

The analysis above shows that supporting for the preceptor burdens too heavily head nurses and exceed their limitations. We need to increase staff support in order for the system to be more effective. Furthermore, it is suggested that the educational division has to not only make and exercise the plan, but also organize the supporting activities in each ward.