The purpose of this study was to identify a comparison of nursing service amounts at a hospitals specializing in treating acute patients and related factors which influenced nursing service amounts around the time of the introduction of Diagnosis Procedure Combination(DPC). Nursing service amounts and related factors were analyzed by t-test and descriptive statistics during the 1-year period before DPC was introduced(May 2002─April 2003), and the 1-year period after DPC was introduced(May 2003─April 2004), utilizing the Kitasato Nursing System(KNS).

As a result, it was found that there were variables of a significant increase in hours spent on other treatments and examinations, hours spent on admitting patients to hospital, hours spent on ambulation and rehabilitation, and hours spent on respiratory care. Significant decreases were in hours spent for special instruction. In the comparison of numbers of patients by type, there were increases in type 5 = patients requiring critical care, and type 4 = patients requiring intensive care ; and there were significant decreases in type 0 = minimal care. The introduction of DPC led to the reduction of hospitalization days, but nursing service amounts increased to critical care and intensive care patients because patients of hospitalization and an aged patients increased, and critical path ways were introduced. Then standardized measurements were required to apply nursing service amounts to DPC classification. It has been revealed that, with more and more critical care and intensive care cases, the number of so-called high-maintenance patients who require care day and night has been increasing for the hospital. Assigning staff to provide safe medical care by which it is possible to deal with the increases in critical care and intensive care cases is an urgent task.

The purpose of this descriptive study was to clarify nurses’ perception of physician/nurses collaboration in relationship to several factors. The subjects were 798 staff nurses at three general hospitals (outpatient facilities, operating rooms, and psychiatry were not included in this study) in X Prefecture. Data were collected through questionnaires. Explanatory affecting collaboration variables were “nursing care delivery”, “supports”, “opportunities of communication with physicians”, “the nursing autonomous attitude against physicians” and “physicians’ attitude toward nurses”. These variables were statistically analyzed using analysis of covariance. Analysis of covariance showed that the factors promoting collaboration were : supports from colleagues, senior workers, nurse manager/assistant nurse managers, and formal opportunities for communication with physicians. Disincentives to collaboration were : the negativity of physician’ attitude toward nurses and lower nursing autonomy. Therefore in order to increase physician/ nurses collaboration, it is important to mentor junior staff nurses by role modeling nurse physician collaboration so they can see positive collaboration in action. And also, it is necessary to show senior workers and nurse manager/assistant nurse managers asserting clinical judgments during conferences and to have junior staffs participate in those discussions. Nurses providing logical explanations about nursing judgments to physicians and discussing those judgments with physicians is crucial in establishing nursing autonomy. Nurses assuming an equal stance and autonomous attitude when stating their case with physicians and respect and mutual understanding each other increased physician/nurses collaboration.

Medication errors for internal use are one of the most serious issues of all malpractice cases by nurses. The greatest problem is involved with the failure of confirmation. So far, there are few reports which analyzed the factors related to the causes or the stages of malpractice occurrence. In this study, confirmation errors identified from the incidents reported in the government publication were categorized according to our own algorithm and analyzed to determine the contributing factors.

The findings were : Confirmation errors, which comprised 70% of all errors, occurred at the stages of confirming the acceptance of doctor's order, of checking the compatibility of nurse's planning with doctor's order, and of the compatibility of nursing action just prior to actual provision with the doctor's order.

The confirmation errors involved with the nurse's acceptance of orders, or with the nurse's actions as indicated above, in addition to confirmation involved with the nurse's evaluation of the validity of orders were categorized by five items of causal factors. A significant difference was observed between the distribution of the related causal factors and that of the entire items of confirmation. Preventive measures should be programmed at each confirmation process.

The objective of the present study was to investigate the relationships among the range of discretion, practical ability, and desired range of discretion for nurses involved with endotracheal intubation and ventilator management. A self-administered questionnaire survey was conducted on 285 nurses who were frequently involved with endotracheal intubation and ventilator management. Cramer’s V was used to analyze the survey findings. The results indicated that, as far as endotracheal intubation and ventilator management were concerned, nurses developed the practical ability based on their current range of discretion, and the desired range of discretion did not exceed the current range of discretion. The number of years of experience in ventilator management was investigated as a related factor, and this parameter exhibited a correlation to the practical ability in ten of the twelve items and to the desired range of discretion in only one of the twelve items. In addition, differences in the range of discretion among the various workplaces correlated to the practical ability and desired range of discretion.

Semi-structured interviews of eight nurses working as part of the middle management regarding the knowledge initiation experience were analyzed by the “modified grounded theory approach” (M─GTA), and knowledge initiation utility through tacit knowledge was examined by explaining a knowledge initiation process pertaining to a nursing practice.

Although the “fixed form of knowledge” continued to grow by transitioning to explicit knowledge during the process, the knowledge that it was considered to impart only in the form of tacit knowledge also existed ; thus, explicit and tacit knowledge initiation progressed simultaneously. Further, the characteristic influences of the Japanese culture were also observed with an emphasis on the nurses' growth and recognition aspects of knowledge.

This suggested that knowledge initiation was promoted by avoiding an excessive use of the fixed form of knowledge, exploiting the cultural trait that tacit knowledge initiation is favorable, and effectively combining explicit knowledge initiation with tacit knowledge initiation.

The purpose of this study was to identify the structure and categorization of how nurses use intuition to predict and prevent falls among the institutionalized elderly. In the study, 25 nurses, including an expert nurse, watched the videotaped transfer and toileting activities of a high-risk faller and predicted when falls would occur. A semi-structured interview method and qualitative analysis were used. The results showed four aspects of the nurses' intuition : direct observation, indirect observation, risk prediction, and intervention. Based on these four aspects, each nurse's prediction was categorized as inactive factor investigation pattern, multidimensional investigation prediction pattern, active interaction pattern, and integral intervention pattern. The results suggested that as the nurses' years of experience increased, intuition changed from inactive to more active and from indirect to direct ; moreover, the variety of intervention methods was wider.