The purpose of this study was to clarify nursing method to help the growth of an puberal case who refused to go to school. The subject was a case of school refusal in puberty whose main symptom was nausea. I gave her support based on one-to-one interview and play therapy. This study was considered from a psycho-dynamical point of view on these three points. (1) the meaning and pathologic point of the inadaptable behaviour of the case. (2) changes of the case through the relation with the nurse. (3) effective nursing supports that caused the changes. These were summary of effects. 1. In the prosess of development of the relationship between the case and the nurse, ego-development and adaptability to school were promoted. 2. A trouble in mutural relation between the case and her mother caused the refuse of feminity acceptance and object homeostasis. I understood that the problem was related to her somatization and that it was the big factor that obstracted her constant ego-development and adaptability to school as the place of social life. 3. It was necessary to place her under acceptable and safe conditions in order to get rid of the somatized symptom and unconcious conflict. The relationship between the case and the nurse who had supportive functions enabled to find a clue to express herself freely and strengthen the stability of her ego. Above mentioned sense of possitive self, encouragement of her independence, and support to improvement of relationship between the case and her mother helped her recover eagerness to life behaviour, and as a result of that I found them also effective to the extention of adaptability to social life.

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The name of "May Syndrome" was created by journalists, addressing the particular type of emotional and mental responses of newly entered university students. The goal of this study is to clarify the actual state of "May Syndrome" and the social support system over the time among 6 nursing university students. The conceptual framework used in this study was theoretical integration of ego identity by E.H.Erikson and the concept of convoy by R.L.Kahn. A set of the self-filling questionnaires including the May Syndrome scale and Amae Network Questionnaire were distributed to the first and second year students in 6 schools twice in June and September. 320 students (72.3%) in June and 227 students (54.6%) in September responded. The study shows that May Syndrome reached the peak in September in the second year and the the score in June in the second year was the second and that was the lowest in June in the first year. Concerning social support, it was found that the size and quantity of social support was shrunk and gradually the students tended to lean more on family relationship rather than expanding friendship relationship for a long time. The educational and professional implications of this study were discussed.

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The purpose of this longitudial study is to identify the degree of the nursing college students' motivation for college life and its influenced factors. The research subjects were 120 students in Japanese Red Cross College of Nursing. The data were obtained by the questionnare two times a year, April and November, from their freshman year to senior year. The major findings showed as follows. The highest motivation rate was April in fresman year, and the lowest motivation rate was November in senior year. The major influenced factors on their motivation were psychological and interpersonal factors. Especially, faculty members' teaching ability to fulfill students intellecutual inquiry, faculty members' active attitude toward research, faculty members' positive role model for students, and faculty members' respectful attitude for students' autonomy made students' motivation higher. Moreover, students' sincere attitude toward learning, and students' mutual support positively contributed students' motivation. The students in higher motivation group showed actively problem solving coping pattern.

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There have been many controversies over "informed consent" of psychiatric patients. It sometimes becomes inevitable for staff to do something without a patient's consent in order to keep his/her safety. A student nurse criticzed staff for being abusive to a highly rejective and regressive female psychiatric patient. The patient did nothing by herself, so that staff had to urge her, for example, to eat or to take a medication everyday. The student nurse was also bitterly refused by her. The criticism the student nurse made arouse a serious discussion among the nurses. Some staff disagreed with her observation, but they decided to reconsider their approach to the patient. Then another student nurse took charge of the same patient, and could manage to make good relationship with her. One day the patient asked the student nurse why she hadn't pushed her hard enough, and admitted that she liked staff to be tough on herself. As a matter of fact violence was common-place in her family. It seemed that she was trying to realize her own family by the severely regressed behavior against the staff. It also became clear that some nurses were aware of and reacted instinctively to her hidden need for dependence. There remained an educational problem in this case. The student nurse who criticised the staff for the patient abuse could not understand the patient's unspoken emotional need, because she was shocked by a patient's severe rejection, although she made good contribution to making better practice of nurses. It is really a difficult matter for teachers how to do with students' straight criticism. We must deal with the students' emotional problems as well as the controversial issues they made.

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The Global Assessment Scale was regarded as an useful instrument for psychiatric nurses and other co-medical professional to assess social adjustment of the mentally ill. The purpose of this study was to examine reliability and validity of that scale using Japanese schizophrenic subjects. The sample consisted of 20 inpatients and 10 outpatients. Interrater reliability showed Pearson correlation r of 0.835, which was successfully high enough. Concurrent validity was examined through correlations between GAS and the score of Daily Living Adjustment Scale (10 items;developed by Hayama for the interview schedule, abbreviated as DA), and GAS and the score of modified version of Psychiatric Evaluation Form (12 items; abbreviated as PEF). Correlations between GAS and DA were 0.699 by the rater 1 and 0.631 by the rater 2. Correlations between GAS and PEF were -0.749 by the rater 1 and -0.837 by the rater 2. In addition, GAS scores successfully distinguished the group of inpatients from outpatients in the sample indicating statistical significance by two-tailed t tests. Therefore, this study demonstrated fairly well results of the interrater reliability and concurrent validity tests of GAS. The instrument appears quite promising to assess outcomes of the care programs for the mentally ill in Japan, though we need further examination of the scale.

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One of the important therapeutic aspects of treating hysterical patients is how to help the patient to acquire a psycological insight into the condition through a therapeutically non-directional approach. With case M, this was considered to be impossible because of her mild mental retardation. She always put both her hands in front of her breast and needed nursing help in almost all aspects of her daily life except excretion, did not show any usual courtesy and had a very poor ability to show her own will and feelings presumably because of her secondary psychological charactaristics as a mentally retarded child. The authors were receptive in their relations with her for a half year; however above mentioned attitude did not basicaly change. We hoped she would develop ordinaly social behavior and promoted this at every opportunity through our nursing process in her usual daily life, accepted what she could do and paid careful attention to her. She gradually began to experience and enjoy communication with other patients and to show volition by imitation of their behavior. When her rigidly grasped hands were put down, we recognized it as a concrete sign of her psychological change. Our prompting and praise of her actions gave her experiences of being counted on and recognized, and was finally effective in helping her to achieve psychological insight, which was difficult for her. One year and three months after admission, she could go shopping by herself and was able to be discharged from our hospital.

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After the "Act of Mental Health "was passed in Japan, psychiatric rehabilitation became even more important. The aim of this study is to define and clarify the role of nursing in psychiatric rehabilitation. Two patients' nursing care were analyzed. The patients were choosen among patients discharged during 1990. The results of the study indicate that to move towards early discharge, it is important to set a therapeutic framework for "care that must be done in the hospital". Nurses need to prepare for patients to do their daily living skills in the community from the day they were discharged. To achieve this goal, nurses must: 1. make a therapeutic framework including a concrete time schedule 2. create a collaborative relationship with patients 3. prepare the support system 4. take a role as a coordinator among the health care team members

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