The purpose of this study was to explore factors which allowed restraint-free nursing care in geriatrics hospitals. Eighteen nurses at four geriatric hospitals where physical restraints had been abolished participated in this study. Interviews were conducted using a semi-structured interview guide. The transcribed data were analyzed qualitatively, and descriptions corresponding to reasons that enabled nurse to abolish physical restraints and reasons that the restraint-free nursing care had been continued without the use of restraints were encoded and categorized. The result showed that there were 3 major categories and 7 subcategories common across all three job levels (① directors of the nursing department or head nursing managers, ② head nurses, and ③ staff nurses). Three categories were : 1) philosophy of organization and leadership, 2) organizational system, 3) nursing practice and 7 subcategories were : ① well-defined hospital policy, ② authority of nursing managers, ③ opportunities for education and learning, ④ risk management system, ⑤ nursing manpower, ⑥ alternative nursing skills to restraint, and ⑦ agreement of family members. In terms of each job level, factors from directors of the nursing department or head managers consisted of 1) management capabilities and 2) support from physicians, and factors from head nurses consisted of 1) awareness of role and 2) shared values. The factors obtained from staff nurses consisted of 1) shared values, 2) awareness of improper practices and 3) pride in one's work. Among common factors to the three job levels, a well-defined hospital policy and authority of nursing managers seemed to be prerequisites for abolishing restraint. It was suggested that the development of alternative nursing skills to restraint along with their implementation allowed nursing care to be provided without the use of physical restraint.

The purpose of this study was to identify the nurses' skills and techniques in geriatric hospitals where physical restraints have been abolished, and to get indications of nursing skills and nursing management to enable to abolish to use of restraints. Eighteen nurses in four geriatric hospitals were interviewed by the use of semi-structured interview guide. All interviews were tape-recorded and transcribed. Content analysis of the data identified 70 codes as nursing skills and techniques which enabled to abolish the use of physical restraints. Those were classified into three categories and 13 subcategories. The three categories were : 1) a technique to establish good personal relationships, 2) an ability to observe precisely and make correct decisions, and 3) a technical skill to provide adequate environment to the patients. 1) A technique to establish good personal relationships consisted of : ① conscious communication, ② sharing time and place, ③ an attitude to try to understand meaning or reason of the patient's behavior, ④ recreation, ⑤ informed consent for the patients and family members, and ⑥ acceptance. 2) An ability to observe precisely and make correct decisions included ; ① a flexible assessment technique regarding a situation, ② prediction of risks and risk factors, ③ review of nursing care, ④ facilitation for moving to normal daily behaviors. 3) A technical skill to provide adequate environment to the patients included ; ① adjustment of physical environment to the patient, ② development of means for handling IV lines, ③ provision of adequate bed linens. These various skills and techniques were identified the significancies between nurse manager and staff nurses. The significancies indicated that nurse manger has wide views that care for family members not only the patient and prevent dangers as risk management.

For highly active antiretroviral therapy (HAART), the most important issue is the patients' adherence to the medication. So, consultation by coordinator nurses (CNs) for HIV/AIDS has been carried out at the outpatient department to support the establishment of compliance to the medication. Here, we investigated the time needed for such consultation and its correlation with various factors at the 4 stages of HAART for each patient. HAART consists of 4 stages : Stage 1 before the introduction of HAART, Stage 2 at the beginning of HAART, Stage 3 less than 6 months after the beginning and Stage 4 more than 6 months after the beginning. Based on the experience of nursing consultation and its related documents, possible related factors were extracted and a total of 356 records of 220 patients who received nursing consultation from July to November 2002 were used as the subjects of this study. The time needed for nursing consultation was 40.9 ± 33.7 min for Stage 1, 61.8 ± 33.7 min for Stage 2, 35.7 ± 23.8 min for Stage 3 and 31.0 ± 21.2 min for Stage 4. The consultation time in Stage 2 was significantly longer than those of other groups (p < 0.05) and it was significantly correlated with the two factors of,"education of the patient"(p < 0.05) and"inability to talk in Japanese"(p < 0.05) . Regarding the purpose of consultation, the most closely correlated factor was the orientation for medical consultation in Stage 1 (p < 0.001), contact and adjustment in Stage 3 (p < 0.01) and the orientation on the first visit of patients referred from another facility in Stage 4 (p < 0.01). Therefore, to meet with a patient with some factors that might change the consultation time, it is recommended to secure a sufficient time for consultation.

Aiming to support patients undergoing highly active antiretroviral therapy (HAART), nursing consultation for outpatients has been carried out by coordinator nurses (CNs) for HIV/AIDS. The types of activities and actions during nursing consultation were investigated for each stage group assigned according to the stage of HAART (shown in Part 1). The consultations given to 14 outpatients were recorded by video camera where the CNs' actions were monitored as the subject. The video recording was analyzed by a time-sampling method every minute and by the checklist method for observation. The actual states of consultation were expressed as the mean proportion of each item in the activities (19 items in 4 domains) and actions (11 items in 2 regions) to the total consultation time for each patient. The most important activity in the nursing consultation was education of the patient (74.7%) in Stage 1 : before the introduction of HAART, support for adherence to the medication (49.2 % and 57.8 % in Stage 2 : at beginning of HAART and Stage 3 : less than 6 months after the beginning, respectively) and support for establishment of adherence to the medication (50.5 %) in Stage 4 : more than 6 months after the beginning. The most frequent actions of CNs during the consultation were explanation (54.0, 41.6, 34.2 and 40.2 %, for Stage 1, 2, 3 and 4, respectively), followed by listening to the patient's opinions (16.0 %, 25.1 %, 32.4 % and 35.7 % for Stage 1, 2, 3 and 4, respectively). It was concluded that the CNs' activities were mainly explanation to enhance the patients' understanding about their own conditions and various explanations were given as answers to the patient's comments.

The purpose of this study is to investigate of Japanese nurses' job satisfaction and to furnish the results and subjects of this research. As for the method, literature from 1988 until August 2003 was looked up on the Japan Medical Abstracts Society's Web edition using the key words "job satisfaction" and "nursing". The "Stamps-Ozaki scale" was used for as the method of research on the 96 pieces of writing targeted. These results were analyzed ; a content code drawn up, and then classified and categorized using the KJ method. The study yielded the following findings :

1. Content was classified in 5 categories : "the degree of job satisfaction", "factors which influence the degree of job satisfaction", "comparison in the hospital or nursing unit", "the relationship of the degree of job satisfaction with other scales investigated in the study" and "a study of the degree of job satisfaction score as an evaluation index for improvement".

2. The total job satisfaction scores were 164.3 ± 25.8 points, an average of 55.5 % of the top possible score.

3. The job satisfaction score was high for such items as "interaction among nurses" and "professional status" and low for such items as "the doctor-nurse relationship", "pay" and "task requirements".

4. The factors which influenced the job satisfaction score are "years of clinical experience", "age", "job position", "rotation based on preferences", "job reshuffling based on preferences", "retention", "individual sense of aptitude to the nursing unit" and "the hospital or nursing unit's characteristics".

5. For several pieces of writing, there were problems with using "Stamps-Ozaki scale" and with the analysis. Accordingly, it became clear that the research results were not entirely accumulated.

6. In future, the subjects of the Japanese nurses' job satisfaction research is to use "Stamps-Ozaki scale" in the way that a supplementary examination is possible to accumulate a research result, to reexamine of the result of research. At the same time, it is important to examine "Stamps-Ozaki scale" itself and to investigate the structure of Japanese nurses' job satisfaction as factor searching studies.

The present study aimed to clarify characteristics of risk-taking behaviors in nursing students. A questionnaire survey was conducted to ascertain the relationship of risk evaluation to critical thinking attitudes and risk-seeking tendencies. The results obtained from 97 nursing students were as follows :

1. Regarding the relationship between risk evaluation and probability of risk-taking behaviors, in everyday, commuting and nursing situations, the probability of risk-taking behaviors assessed as being high risk was low. This tendency was particularly strong in nursing situations.

2. A group of nursing students who underestimated risks and were more likely to undertake risk behaviors in everyday situations also tended to underestimate risks and were more likely to undertake risk behaviors in both commuting and nursing situations.

3. In nursing situations, risk evaluation exerted a strong effect on risk-taking behaviors, while critical thinking attitudes significantly affected risk evaluation. Conversely, risk-seeking tendencies exhibited no direct effect, and this differed from everyday situations.

These findings suggest that, in order to increase the level of sensitivity to risks and help students to take more appropriate behavior, fostering the attitudes and abilities of nursing students is important, so that they can accurately assess risk situations and their own knowledge and skill.

In order to investigate the effectiveness of curricula, educational methods and clinical practice systems for developing practical nursing skills within basic nursing education, a group interview was conducted to ascertain the current state of work performed by new nursing university graduates assigned to ICU and acute care medicine. The feelings and emotions experienced by the new nurses (n=5)during the early stage of employment were roughly divided into two categories : "work-related" and "interpersonal relationships and support systems". The "work-related" category was further divided into "achievement", "approval", "responsibility", "specialty" and "work conditions", while the "interpersonal relationships and support systems" category was further divided into "directionality", "supervision", "co-worker relationships", and "supervisor-subordinate relationships". Most experiences were recalled without much emotion, suggesting reality shock. However, the subjects discussed "directionality" with much emotion, demonstrating that "directionality" in current education appears to be a factor that suppresses new nurses from leaving work during the early stage of their employment. Along with focus on clinical nursing practice and the need for nursing management to deal with workplace stress, the importance of developing support systems for career development which include stress management and practical skill education was identified as a future task in basic nursing education.