In an increasingly globalized society, Japanese nurses are required to provide care to culturally-diverse patients. Nursing students, who are responsible for clinical nursing in the twenty-first century, also have the imminent necessity of acquiring English fluency crucial for cross-cultural nursing. With the aim to improve nursing students’ knowledge, skills and attitudes through simulated learning in an international setting, faculty conducted foreign simulated patient（hereafter, SP）care practice as a part of a compulsory subject called Practical Nursing English. This article describes the half-day practice we provided for nursing students, reports about the assessment of the program conducted by nursing students, SPs, nursing faculty, and native English instructor, and explores suggestions for improvements. Two hundred second-year students participated in the practice under the guidance of four English faculty and three nursing faculty members. Eighteen simulated patients from twelve different countries were recruited for the event, which provided a more realistically-diverse clinical situation for nursing students. Though it was only a three-hour long class accounting for two regular class meetings, the collaboration of both English and nursing faculty for the simulation program proved to be an interdisciplinary and inspiring event. The questionnaire results were highly favorably both among nursing students and foreign SPs. The course resulted in motivating students to acquire more knowledge, more advanced skills, and better attitudes necessary for cross-cultural communication in a clinical setting. The program also taught nursing students that language and cultural barriers should be opportunities for increased professionalism because all patients are vulnerable regardless of differences among them, such as gender, age, and nationality. Suggestions were made by the simulated patients and faculty for further improvements in the simulated patient program including the time allocation for patient assessment, students’ preparation before the practice, and the appropriate number of SPs for our class size.

　Purposes；The two purposes of this study were to reveal physical restraint prevalence in intensive care units（ICUs） in Japan and to discuss its association with patient-to-nurse ratio focusing on nursing workload.

　Methods；This cross-sectional observational study targeted 462 dedicated ICUs across Japan. Self-administered surveys were mailed to nurse managers, and anonymously returned surveys were quantitatively analyzed.

　Results；The response rate was 25.1%. Physical restraint prevalence was 28.8% and the incidence rate was 4.61 per 1000 patient-days. There was no significant association between patient-to-nurse ratio and physical restraint prevalence, and no significant difference in the prevalence was found between high and low patient-to-nurse ratio groups. Multivariate regression analysis revealed that mechanical ventilation and use of a written physical restraint procedure were independently associated with the physical restraint prevalence.

　Discussion；Physical restraint prevalence in ICUs in Japan was similar to that in foreign countries, and our results suggest that it is higher than that in general wards. Arbitrary selection upon the application of physical restraint could explain the lack of association between patient-to-nurse ratio and physical restraint prevalence. In addition to the previously reported factor of mechanical ventilation, the use of a written physical restraint procedure was found to be associated with physical restraint prevalence; thus, its implementation may play an important role in optimizing physical restraint practices.

　This study aims to develop a competency rating scale for head nurses in realization of work-life balance among nurses. We identified constructs of competency based on interview results and a literature review, created questions about competency, and developed a scale based on the examination of questions and concepts. We then prepared a draft of a scale comprising 83 items.

　We conducted a questionnaire survey of head nurses using the original scale measure, 289 questionnaires were analyzed. The following 9 factors composed of 41 items were constructed: “clarification of organizational goals and career support,” “sharing of vision,” “administrative management that utilizes individual competency,” “problem-solving activities in nursing practice,” “promotion of understanding of the support system of work-life balance,” “attainment of transparency and fairness in taking holidays,” “responsible behavior as middle managers,” “flexibility underlying the construction of interpersonal relationships,”and “approval that enhances motivation of staff nurses”. In future, we will conduct surveys among head nurses nationwide, to further refine the scale, assess its criterion-related validity, and propose possibile utilization of the scale.

　The purpose of this study was to show that logical sequence like in Piaget and Kohlberg’s stages is included also in Erikson’s stages of ego development, by considering Erikson’s each stage representing each form of self’s fulfillment. We discussed that in Erikson’s stages from the first to the fifth it is described under what conditions the sense of agency is experienced, and that these stages progress along Piaget’s cognitive development and toward differentiation and integration of perspectives, which influences to experience of sense of agency and the person who supports that experience. While Erikson is criticized that his theorization is slanted toward individuation, we considered that he treats both individuation and relatedness : from Ⅰ to Ⅴ are the developmental process of individuation, and Ⅵ, Ⅶ（and Ⅰ） are that of relatedness. We discussed that mutuality, one aspect of relatedness, is the core of ego development in these stages, and that there is developmental difference in what kind of position one experiences mutuality.