Objective: The purpose of this study was to identify the factors influencing hand hygiene behavior (compliance and quality) of nurses strongly and to provide suggestions for improvement.
Method: An observational study and a questionnaire survey were conducted with 93 subjects, nurses at the two hospitals. Factors were experience, education, concern of infection control, knowledge, and workload: intensity of patient care and understaffing.
Results: Factors influencing compliance were identified as intensity of patient care, education, and experience. Factors influencing quality of hand hygiene were identified as intensity of patient care and understaffing. Noncompliance was higher when intensity of patient care was high (compared with <25 incidents of patient care per hour, 25 to 34 incidents: OR (odds ratio). 7.75 (CI, 1.54 to 39.03);> 35 incidents: OR. 12.99 (CI, 1.64 to 102.72)). Quality of hand hygiene was inferior when intensity of patient care was high (compared with <25 incidents of patient care per hour, 25 to 34 incidents: OR. 6.86 (CI, 1.43 to 32.95);> 35 incidents: OR. 28.52 (CI, 2.43 to 335.08)).
Conclusion: These results suggest that factors influencing hand hygiene behavior may be workload, education, and experience. In order to improvement of hand hygiene behavior, improvement of patient care system, recommendation and training for handrub, and enforcement of hospital-wide educational program of infection control may be useful.

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The purpose of this study was to investigate the processes of decision making for the preventive-operation in the patients with asymptomatic cerebrovascular diseases.
In the domain of preventive surgical treatment for asymptomatic cerebrovascular diseases, there are still many uncertain and controversial elements. Meanings of the experiences of patients who undergo the preventive-operation are not known. Using qualitative method, we analyzed open-ended interviews of 15 patients who underwent the preventive-operation, it was found that the process of decision making has two main dimensions. One was explained as category of sequential process, and another was explained as category relevant to the process. In the sequential process-category,'confusion,''hesitation/fluctuation,''examination of the prospect,' and'decision making which is like a bet/at the risk' were accrued sequentially. The elements-category consisted of internal emotions and experiences of the interpersonal to external human resources. The internal emotions included'perception of distance from illness' and 'perception of becoming a sick person temporarily.' And experiences in the interpersonal to external human resources 'perception of being connected with the doctor' and 'adhering to the family functions.' Those patients intuitively felt presentiment that they might have an attack right of the diagnosis. In this study, we revealed that patients made a decision under the serious uncertainty.
However, nurses had hardly participated in their hard situation to support the process of the decision-making. Since it is expected that patients with asymptomatic cerebrovascular diseases will increase, nurses need to establish the additional role to support the decision making of these patient.

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The purpose of this study was to investigate the actual conditions of handling personal information in clinical training and to clarify the ethical issues involved, so as to examine the ethical education system at nursing universities. Educational directors of 83 nursing universities in Japan were asked to respond to a mailed survey. Questionnaire items included: the manner in which patient information was obtained and recorded, the nature of the information requested, the manner in which the forms were kept, and the question whether patients were informed that their personal information would be accessed by nursing students.
Replies from directors of 44 universities (a collection rate of 53.0%) were received and analyzed. Results showed that over 75% of the nursing universities directed their students to record 11 items of personal patient information, including name, age, sex, family members, date of hospitalization, and occupation. Also, more than 40% of the universities allowed the students to delete every other character of the patient's name thus making easy identification of individual patients difficult. During clinical training, 95.5% of the nursing universities held their students individually responsible for the keeping of the forms, and after clinical training, 63.6% of the universities continued to hold the students responsible. Only 34.1% of the patients were informed that their personal information was being accessed by students. These results show that the actual conditions of handling personal information in clinical training involve ethical issues such as recording unnecessary personal information, accessing personal information without informed consent, and individual keeping of the forms by students.

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E-learning (EL) is expected to provide a useful means of resolving existing time and physical-related restrictions imposed on the delivery of Master's level and continuing professional nursing education within Japanese colleges. Based on a recent needs survey of 1, 270 nurses working at domestic health, medical care and welfare facilities, we developed a hypothesis and model of EL causal relationships. Factor analysis and covariance structure analysis were used to explain the hypothesis and model. The following results were obtained:
1. The desire to utilize EL will increase if concerns are reduced about lack of direct communications between participants, students learning by themselves in the absence of other students, curriculum and cost.
2. The desire to utilize EL will increase if credits toward college degrees and nursing certifications can be earned through EL.
These results suggest that when introducing EL as a means for Master's level and continuing professional nursing education, it is essential to provide opportunities for direct communications among and between students and faculty (e. g., occasional sessions at facilities and interactiv education); and allow students to receive credits towards college degrees and nursing certifications.

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The objective of this study was to clarify the process of socialization of mothers who have twins, one of whom has a disability, and to examine their interactions with their husbands, children, and people around them using the Grounded Theory Approach.
The subjects were 14 mothers with a spouse and twins, one of whom had a disability.
The mothers with a disabled twin followed the socialization process of (1) beginning of nursing of twins, (2) perception and assumption of the role of a mother with disabled and healthy twins, (3) relief from conflict with the stereotype of twins, and (4) becoming a person who is helpful to others. They first“acquired the stereotype of twins”during the period of pregnancy, felt “bewilderment due to the unfamiliarity with the disability”and “preciousness of life regardless of the disability”characteristically of parents of disabled children, experienced“looking squarely at the disability by comparing the twins”and“being busy with nursing twins one of whom is disabled”characteristically of parents having a disabled twin, and eventually“perceived differ-ences between their own consciousness as a parent and that of their husbands.”
The mothers established their independent attitude of“developing mental strength”and“assuming the responsibility to support their disabled children”and acquired the role as a mother by“overcoming the temptation to hide the disability”and“understanding the two worlds simultaneously.”From the dilemma of“not being able to love the twins equally”and“feeling that it was fortunate that they were twins,”the mothers also thought that“the twins were not twins in reality because of the wide difference in their development”and that“it was natural to discipline them differently even though they were twins.”
The results of this study facilitate the determination of the timing of nursing support for mothers with a disabled twin, and suggest the necessity of the establishment or improvement of a family nursing system them.

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We have organized a bereavement support group for families who have lost their family member to cancer to facilitate the recovery from grief. The purpose of this study was to consider the meaning of bringing things for the deceased's memories and talking about them in the bereavement support group. The subjects were eleven bereaved. The experiences of the bereaved were analyzed qualitatively. The results were seven focus meanings of the themes. The meanings were as follows: (a) remembering and narrating about the relationship and history with the deceased, (b) expressing their grief openly, (c) accepting their dying and encouraging to live through sharing their feelings with other members, (d) feeling relieved or thanking the deceased through remembering their love to them, or hoping that they will be able to feel relieved or thanking them, (e) realizing that the bereaved have accomplished the roles for the deceased, (f) empowering to live positively through being aware of the symbols that things for the deceased's memories mean, (g) fixing the deceased's new position for the bereaved and realizing that they are taken care by them. The results indicated that bringing things for the deceased's memories and talking about them brought realizing the continuation of the history between the bereaved and the deceased and recovering the continuation of the interconnectedness with them, then would lead recovering the sense of continuity between the present and the past that the bereaved had lived with the deceased. It was suggested that the above three was the process of a recovery from grief.

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