The purpose of this study was to identity clients' conditions of outcome and cost-effective factors in home care. Subjects were 383 clients who received home care at 5 visiting nursing stations and were to be the subjects of the long-term insurance. Method of outcome evaluation was that nurses recorded the change of clients' conditions in the questionnaire consisting of OASIS 14 items at the beginning and end of two months during visiting nursing. Clients answered the questionnaire consisting of service satisfaction items and care outcomes. Cost-effective analysis was to measure cost divided by clients' conditions and outcome average score. Cost was visiting nurse service cost for the two months. Each rate of cost to effectiveness was distributed to four areas and we analyzed a relationship between rate of cost and clients' conditions by nonparametric test and χ² test.

As a results, client outcome evaluated by nurse was mostly "stable". Overall clients' satisfaction was high. Clients with low level outcome score (grooming, transportation, breath, urinary incontinence and bedsore) received highly expensive services. Clients' conditions of cost-effective factors were independent level, dementia, and serious stage. Therefore, clients with medical treatment such as catheters care, tube nutrition and bedsore care had worse cost-effectiveness. Although the conditions were not improved in the highly demented group, clients' satisfaction was high and it resulted in better cost-effectiveness on satisfaction. It is necessary to improve and manage client independency, prevention of dementia degeneration, high level care such as incontinence, bedsore and breathing for better efficiency.

The effect of fresh nurses on nursing service in the hospital was investigated using questinnaires sent to 89 head nurses. The questionnaire was made on the basis of a head nurse function list. Twenty-eight items on "practice", "management", "education" were devised to evaluate the effect of fresh nurses.

The results showed that the effect on nursing service was high in the order of "education", "management", and "practice". "Practice" and "management" were especially effective in the group with the strong effect.

We compared the effect in 3 groups divided by the proportion of fresh nurses. In "practice" and "management", the effect in "high group" was stronger than in "low group" and "middle group". Some educational effect was found in nursing team with fresh nurse. It is concluded that the ideal proportion of the fresh nurse is around 12~14% and the daily nursing service is reversely affected in the proportion over 18%.

Along with the drastic changes occurring in the Japanese health insurance system today, nursing fees concerning nursing care that take into account by the level of nursing needs has been examined. The authors have currently conducted research to study an appropriate method of introducing a nursing needs index using the "Nursing Needs Necessity Chart" prepared by the "Nursing Needs Research" Committee of the Hospital Administration Study Association.

Nursing staff engaged in direct care at 20 hospitals in Japan gave consent and checked the nursing needs of their inpatients; they were asked to record the time consumed for the checking and for data input, as well as their opinious and impressions in participating the study.

Guidance for checking was given to representatives from the hospitals for about two hours, and those who received the guidance provided an explanation to the staff.

Two point five eight minutes was used to check each patient and data input was average 1.48 minutes. The mean time for one person to check the needs and input the data was 2.60 minutes. "Difficulty on judgment" and "burdens of the study" were frequently stated opinions.

These results suggest that a preliminary in study meeting for better understanding of the concept of level of nursing needs and the checking chart should be held in order to incorporate the "Nursing Needs Necessity Chart" used in the current research into routine nursing practices in the future. The results also suggest that need to minimize the time by preparing a detailed manual and improving the input system itself.

The purposes of the study are: ①to examine the accuracy of the tool called "Nursing Needs Check" developed by the government, ②to discuss appropriate methods for reliable application of the tool, and ③to investigate the causes for disagreement among three different roles of nurses.

Two hospital wards practicing term nursing were selected from 20 hospitals appointed by the government for the study. The two wards were from different hospitals. In each ward, three different roles of nurses, the head nurse, the team leader, and the nurse who took care of patients, checked each patient's nursing needs using the tool.

The agreement rate of each item for each patient among three different roles of nurses was compared. The lowest agreement rate item is "anxiety (36%)," following by "condition (51.6%)," "washing hair (55.9%)," "blood pressure check (61.3%)," "transfer method (65.2%)," "nursing needs (65.4%)," "rest (65.6%)," and "getting up (70.6%)."

There are eight reasons for the low agreement rate.

1) The nurses did not understand the concept of the tool and the nurses' ability of assessment varies. 2) The nurses judged patient's condition using their own standard. 3) The patients' condition varies during the shift, which makes difficult to determine the condition at the specific time of the day. 4) The nurses had a hard time to determine whether they should answer by the order or actual patient's condition. 5) Some items occur very rate that makes nurses difficulty to judge correctly. 6) The nurses' record was not appropriate. 7) The different time period to determine the condition that makes complicated. 8) The expressions of choices are not appropriate.