With the aim of contributing to the development of effective discharge planning, we conducted a survey on the status of implementation of discharge planning and assessed associations between implementation methods and length of hospital stay.

The subjects the study were ordinary hospitals with 300 beds or more and special function hospitals in Tokyo Prefecture. Valid replies were obtained from 40 institutions (70.2 %). Nurses were involved in every stage of discharge planning, and they generally provided guidance and coordinated therapeutic regimen. Many medical disciplines are involved in discharge planning, and the proportion of their contribution varied according on the stage. The mean length of stay in the target hospitals was 20.4 days. The length of stay was shortest in institutions that replied: "We start discharge planning soon after patients are admitted", "We have criteria for drawing up discharge plans", "We have post-discharge care-support system", and "We have a large number of MSWs assigned per patient.

These findings suggest that establishing a starting time and methods of discharge planning as well as post-discharge care-support methods are important to constructing an effective discharge plan. The participation of many medical disciplines in discharge planning is essential, and nurses are expected to fulfill the role of discharge plan coordinators.

The purpose of this study was to clarify the process of career development among clinical nurses and to identify those factors which influence that process, with the aim of promoting the kind of career development necessary for providing high quality nursing care suited to the changing times. The subjects for the study consisted of 57 clinical nurses working in a private university hospital in Tokyo. The qualitative data were collected through semi-structured interviews based on a questionnaire developed by the researcher and analyzed through exploratory content analysis from which a number of relevant categories were induced.

The study yielded the following findings:

(1) The process of career development among clinical nurses were found to consist of six stages: Stage I: Acquisition of basic knowledge and technical skills; Stage II: Acquisition of leadership ability within a team situation; Stage III: Search for or exploration of one's area of interest/specialization; Stage IV: Defining one's area of interest/specialization; Stage V: Pursuit of skill and expertise in one's chosen area of specialization; Stage VI: Organizing and managing a team within one's area of specialization.

(2) Classification of subjects on the basis of the stage they had attained in the process of career development thus far showed the following. All the subjects had gone through stage I and II; 9 were found to have remained in stage III; 11 were in stage IV; 28 had advanced to stage V; 9 had attained stage VI. The average age of those in stage III was 31.8 years; in stage IV, 36.8 years; in stage V, 37.1; and stage VI, 41.9 years.

(3) Six factors were found to have influenced the process of advancement through the six stages of career development among the subjects: opportunity for study/learning; relationship with patients and their families; influence of one's colleagues and superiors; assignment of various roles and responsibilities; opportunities for gaining experience in various sections within a hospital; events in one's personal life.

The results of the study indicate that clinical nurses are in the process of undertaking conscious efforts toward developing their careers as a profession. The study also points to the types of support systems that need to be put in place in order to enable clinical nurses to advance beyond Stage IV ("Defining one's area of interest/specialization") to the point where they can contribute to the further advancement of knowledge and skills in their particular area of specialization.

In order to obtain data to expand outpatient nursing care in the future, a study was conducted on what kind of situation of people need consultation and guidance by nurse of the scope for "home care guidance fees" and what are the positive outcome of nursing intervention at the usual practice. The subjects were 358 nurses who participated in a study meeting on outpatient nursing, and a survey using self-administered questionnaire was conducted.

The situations of the people whom more than 50 % of the nurses recognized as needing consultation and guidance outside the subjects for "home care guidance fees" were diabetes without the use of insulin, renal disease or dialysis, cancer chemotherapy, management of decubiti, the elderly or demented, or their families, and patients/families requiring psychological support. The older the nurses, the longer their outpatient service, and the longer their years of nursing experience, as well as the greater the mean number of outpatients and numbers of outpatient clinics, the more items of situation they recognized as requiring consultation/guidance (p<0.001). There were 93 (26.0%) who cited a total of 127 instances of examples of positive outcome of consultation/guidance outside the subjects for "home care guidance fees". The most common was "outcome related to physical aspects" (49 instances), followed by "outcome related to feeling/emotional aspects" (33 instances), "outcome related to the cognitive/behavioral aspects" (33 instances), and "outcome related to daily life with therapeutic regimen" (9 instances).

The situations of the people for whom the need for consultation/guidance outside the subjects of the application was recognized as necessary corresponded to the examples of positive outcome, suggesting that the indications in terms of life with therapeutic regimen by nursing support on an outpatient basis are actual subjects whose QOL can be improved.