The aims of this study were to develop the evaluation scale of a risk manager's role for head nurses and to examine its reliability and validity. Using questionnaires, which required 1,167 head nurses in national university hospitals and general hospitals with more than 400 beds to freely describe the role of a risk manager as a head nurse, data were collected from 859 respondents. Sixty-eight items in relation to the role of a risk manager were obtained from the respondents' free descriptions, the literature review and the examination of its validity by general risk managers and researchers of nursing management.

Twenty items of those were dropped by using the Stepwise item selection analysis because of the decrease of their GFI value. The exploratory factor analysis, then, revealed that the scale had following six factors : ‘giving specific advice on the prevention of accidents in clinical nursing', ‘making the most of incident and accident reports', ‘cooperating with the relevant departments and the MRM committee', ‘providing education and support for staff on risk management', ‘coping with the occurrence of accidents', and ‘the proper use of an accident prevention manual'. In addition, the Stepwise exploratory factor analysis made each factor with best fitting, and the Cronbach's alpha coefficients were above 0.95 in all factors. Therefore, it was considered that its reliability was demonstrated to create the six factors.

In conclusion, this scale will be useful to evaluate a risk manager's role for head nurses, and result in the effective performance of their own duty as risk managers.

To clarify the actual conditions under which counseling services are performed by nursing professionals in Japan for diabetic outpatients not using insulin, a postal survey was conducted using a self-administered questionnaire.

The subjects of the survey consisted of nursing professionals(nurses, public health nurses, midwives, and jyun-kangoshi)who worked at 179 hospitals containing more than 200 beds, acted as counselors in outpatient clinics, and who spent more than 30 minutes with each patient.

Overall, 70.1 % of the nursing professionals who responded to the survey had worked in an outpatient clinic for more than 10 years, and 28.5 % held administrative positions. This finding indicates that counseling requires a high level of skill and relevant clinical experiences.

In hospitals where nursing professionals counseled outpatients with diabetes, the nurses accounted for 72.1 % of the medical team for diabetes. This finding suggests that nursing professionals play an important role in the medical teams that are responsible for the management of diabetes.

The fact that most nursing professionals counseled their patients while performing other work suggests that consultation systems engaging nursing professionals have not been established in many hospitals in Japan.

Many nursing professionals used a single room(not specifically for counseling purposes)to counsel patients to assure patient's privacy.

Nursing professionals tended to counsel outpatients who also saw a physician specializing in diabetes or who had been the hospital before. However, only a few diabetic patients who were seeing other specialist were counseled by the nursing professionals. Nevertheless, such patients may also be in need of counseling.

The purpose of this study was to identify effective home care for clients in areas of IADL, ADL, and "the will to live". The subjects were 299 clients whose scores in IADL, ADL, and "the will to live" were surveyed for a period of two months. I analyzed relationships between care degree of implementation and, IADL, ADL, and "the will to live"

As a result, areas which showed high rates in care aimed at promoting independency were "listening to topics related to past events and anxiety" and "encouragement and affirmation". However, care plans which were performed relating to IADL were low, and care aimed at promoting independency was low overall. Characteristics of effective home care in the areas of IADL, ADL, and "the will to live" were seen in the following four areas : ① Partial care(watching over the client)to promote independency, ②Care plans for home rehabilitation, ③Opportunities for exchange with others, ④Control/management in taking medicine.

Therefore it was made clear that the effective areas are : "partial care to promote the client to eat independently", "practice stepping and/or standing up", "encouragement in holding relations with family and friends", "control/management in taking medicine".

It can be concluded that it is necessary for care managers, management, and each care provider to work together to bring a mutual potential effect from the care services to promote client independency.

Due to drastic changes in the circumstances encompassing medical care, the length of stay is becoming shorter in acute care hospitals. It has been discovered that in such hospitals, preceptorship, a widely recognized system for training nurses during the first year of their career, is not in fact functioning effectively. The purpose of this paper is to describe the current status of the system and to propose some ideas to enable preceptorship to be applied effectively.

The personal characteristics of first-year nurses and the current content of the basic education in relation to professional development, in particular practical training, are very different from the actual conditions in acute care hospitals. In such clinical settings medical technology is highly developed and becoming increasingly complicated and patients whose conditions are serious and may change drastically are treated. Consequently, it is understandable that first year nurses can be reality shocked when faced with the real situation. The problems of the preceptorship system as currently applied include:

1. Requirements for application of the system are not guaranteed;

2. Training is given not by preceptors themselves but by those who are working on their behalf;

3. Preceptors feel they have excessive burdens, and experience isolation and dissatisfaction with their achievements;

4. There is a difference in understanding of the duties between preceptors and nurse managers.

Taking into account such actual conditions, preceptorship could be applied effectively if:

1. The reason for application of preceptorship is clearly explained and its purpose is simplified;

2. A preceptor is selected specifically for each purpose;

3. Delegation of authority is facilitated;

4. A support system is established;

5. Feedback of information is practiced specifically for first-year nurses;

6. Knowledge of the purpose and operation of preceptorship is shared.