The purpose of this study was to confirm the validity of conducting chart reviews by nurses in Japan to detect one or more of 18 explicit criteria described in “The Quality in Australian Health Care Study” as indicators of potential adverse events.

A sample of 200 records of hospitalized patients from a population of non-psychiatric patients discharged from two private hospitals was used in the study. Initially, the charts were screened by trained RNs. To test the validity of the screening process conducted by the RNs, all the records were subsequently reviewed by physicians, who also determined whether an adverse event had occurred. In Japan, we adopted the methodology that a nurse supervisor examines only cases screened as negative after the trained nurses conducted retrospective chart review in the first stage.

The sensitivity and specificity of the screening process conducted by the nurses were 100.0% and 60.2%, respectively ; this specificity was lower than that of the screening process conducted by the Australian nurses in the study mentioned above. One reason for this discrepancy is that the operational definition of intensive medical treatment and care-to-cure patient injuries caused by health care was unclear ; thus, nurses had difficulty screening for potential adverse events.

In conclusion, the specificity of the chart screening process conducted by nurses must be improved by presenting actual cases to clarify the definitions of adverse events, while maintaining the high sensitivity.

The purpose of this study was aimed at a nurse manager making clearly of what management style is taken to the partner whom she has recognized the conflict with.

It investigated by using a semi-structured interview guide for 20 nurse managers who work in two public hospitals in the Kansai area. The contents acquired by the interview were analyzed based on the continuous comparative-analysis method of grounded theory approach. The study yielded the following findings.

1. The ten sub categories of <refusal>, <compulsion>, <compromise>, <persuasion>, <appeasement>, <concession>, <collaboration>, <pretending>, <reservation>, <use> existed in ≪conflict management style≫ which a nurse manager uses to the partner whom she has recognized the conflict with.

2. As four sub categories of <reservation>, <use>, <persuasion>, <pretending> which were newly extracted by this study, it was suggested that the all styles are reflected from the cultural feature of Japan in that non-claiming and ambiguity is to be maintained.

3. As a future subject, it was thought to be required to retest in the institution from which a scale and organization structure differ and for a long period of time, the two following investigations : to perform data collection which incorporated participation observation, to put the source of data collection is not only on a nurse manager but on the partner whom she has recognized conflict with.

The purpose of present study was to clarify the present situation and characteristics of cooperative sections with community(called as ‘section')in acute-care hospitals and their influence on the length of hospital stay.

The questionnaires were sent to 55 nursing directors in acute-care hospitals except for a maternity hospital of all 56 hospitals notifying emergency care in Kobe City on Japanese Hospital Catalogue '03―'04. Replies were obtained from 39 hospitals(70.9% of a recovery rate), and effective replies were 35. Twenty-eight hospitals(about 80%)had the section, but many hospitals had set the section for as short as 3.5 years on average. In the hospitals that had a medical social worker in the section, the average length of hospital stay was short, suggesting that the arrangement of a medical social worker may shorten the average length of stay in acute-care hospitals. There was no significant difference in the length of stay between the hospitals with sections with and without nurses. However, the importance of nursing function that supports patients who were able to receive care at home was suggested, because the length of stay were short in hospitals that mentioned “increasing patient received care at home” as an effect of the section. The average length of stay was short in the hospitals that had a route from wards as a patient introduction process of its section and that mentioned “the shortage of knowledge about the cooperation with community in the staff” as an issue. Therefore, the necessity for enlightenment of not only the section but also all staffs and the importance of systematization of an introduction route and support by nurse managers were suggested.

The current research places an investigative focus on the “Hiyari-hatto” experiences of 54 nursing students which occurred during their clinical training, and involves an interview survey that specifically targets 11 of such students with Hiyari-hatto experiences. The actual situation regarding these Hiyarihatto experiences was analyzed and examined in line with the stages of their occurrence. Consequently, the following points were elucidated.

Approximately 40% of the nursing students had been through a Hiyari-hatto experience. Among the individual training areas, Hiyari-hatto incidents occurred most often during “acute phase' -related training and also during “treatment care” assistance training. As for the stages of occurrence, there were seven cases(out of the total of 11)involving insufficient preparation for administration of care, and among these seven, five cases revealed student anxiety regarding administering care. Seven categories were seen for the causes of Hiyari-hatto experiences, namely “lack of precaution,” “lack of knowledge/skills,” “relationship with the hospital staff,” “difficulty in estimating risks,” “insufficient understanding of the patient,” “inadequate communication,” and “inadequacy regarding clinical environment/facilities.” Among these, the highest number of cases was seen in the categories “lack of precaution” and “lack of knowledge/skills.”

As described above, the causes that trigger Hiyari-hatto incidents are in many cases “lack of precaution” and “lack of knowledge/skills,” which suggests that such incidents occur in relation to insufficient preparation for the administration of care and anxiety towards administering care.

Purpose of the Research I'd like to propose a reform activity in the community from an administrative point of view by contrasting with the requirements which were reached by it that the public health center engaged in and the conditions exerting influence on it of the organization.

Objective/Method of the Research The objective is the activity case of public health nurse who worked on the establishment of the integration system (the Council) of the joint project which the public health center and the educational administration had in community A from April in 1998 to March in 1999.

As data for the research, about 50 sheets of the relevant conference data and about twenty thousand characters of the conference minutes (verbatim records) were employed.

Inductive qualitative research methods were employed for collecting/analyzing data. The requirements of “the goal of the reform, the vision, and formulation of a concrete plan” were reached through it.

Furthermore, I contrasted the requirements with “the conditions exerting influence on the reform activity” of the organization.

Results and Conclusion The process of the establishment of the council was a part of the administrative activity in the community that is on how to design a plan (an instrumentality) to provide the budget and resources for the residents efficiently.

It was the reform activity that has enabled to undertake a joint enterprise and to organize the conference by integrating the respective project from correspondence of the former related organizations and parties.

I am convinced that the reform activity in the community was a indication of a part of the activity from an administrative point of view since the principles of business administration are consistent with it in the area owing to the resemblance between “the conditions exerting influence on the reform activity of the organization” and “the requirements of the goal of the reform, the vision, and formulation of a concrete plan.”