The aim of this study was to evaluate the risk factors of falling using a fall assessment score sheet of our hospital. We investigated 1651 inpatients between January and September in 2014. Seventy patients had experienced falling. Logistic regression analysis showed the rate for falling of patients with active rehabilitation and taking sleeping pills was significantly high. It is necessary to obtain a close cooperation with ward staffs and adjustment of medical treatment environment to reduce the incidence of falls.

Yokohama Medical Center participated in Medical Safety Nationwide Joint Action “PARTNERS” in 2012, and registered officially in Action Target 3b：observance of safety guide concerning central venous catheter (CVC) procedure.

The CVC committee was consisted of cardiologist, anesthesiologist, critical care and emergency medicine doctor, gastroenterologist, surgeon, medical safety management nurse, infection management nurse, and hospital clerks. All committee doctor members shared awareness of medical safety regarding CVC procedure by participating in CVC workshop held by Japan Council for Quality Health Care Patient Safety Promotion. The CVC committee established the CVC registered medical doctor system, education system, equipping circumstance, and the implementation record.

The lecture titled “Medical safety based on real experience in CVC malpractice” was held for the whole hospital staff to raise awareness of medical safety at the beginning of 2013 fiscal year, and the system was smoothly launched. The implementation data collection contributed not only to illuminate our hospital CVC status but also to improve the acquisition rate of written CVC informed consent by prompt intervention according to data analysis and feedback.

Holding co-awareness of medical safety regarding CVC is important for smooth launch of the CVC registered medical doctor system. The CVC implementation record collection and feedback allow for safer CVC system establishment.

The study aimed to clarify the current state and issues of tuberculosis examinations for medical facility employees to prevent tuberculosis infection.

A self-administered questionnaire survey was conducted at 10 facilities that consented to participate among 12 medical facilities with 100 or more beds in Ichinomiya city and Inazawa city of Aichi Prefecture. Results of an interview survey conducted on seven screening supervisors of the facilities regarding employee's tuberculosis examinations and subsequent support were qualitatively analyzed.

Tuberculosis had occurred at eight facilities in the previous five years. Between 3 and 80 individuals (maximum numbers at each facility) had undergone contact examinations. Six individuals at two facilities were infected but none were onset cases. Content analysis results extracted three categories in the current status and issues of tuberculosis examination：“mixing of individuals of registered and not-registered in tuberculosis infection baseline data at the time of employment,” “poor management of tuberculosis examination data,” and “lack of preparation to respond to interferon-gamma release assay-positive individuals.” Two categories were extracted in tuberculosis contact examinations：“difficulty of managing contact examination results from employee's data,” and “limitations of follow-ups using regular medical checkup.” The following issues were clarified by these categories：baseline data regarding tuberculosis infection was difficult to manage and utilize as the type of tuberculosis examinations performed at the time of employment differed depending on the year of employment；contact examination data was not accumulated in each employee's data；and tuberculosis cases repeatedly appeared within facilities and the number of individuals subjected to follow-up after contacts examination was accumulated, making it difficult to provide support. We found that it is important to establish methods to enable infection control to provide ongoing support for employee's following tuberculosis examinations.

Previous studies on syringe exchange in catecholamine administration reported minimum influence on the change in circulation despite various methods being utilized. The method performed by our ward had been a parallel exchange to increased and decrease the flow quantity. We have progressively adopted the two-syringe pump method. However, this complicated exchange maneuver required twenty minutes. We examined the 4.0ml catecholamine-filled connecting tube with on/off switch method reported by Nakanishi et al that was found to be a safer exchange method. The two-syringe pump method requires that both tubing is filled with catecholamine and a relay switch is utilized to change from one syringe to the subsequent syringe. Various types of T-shape stopcock exchanges were analyzed using glucose solution and tested for density. As a result, the opening-type T-shape stopcock had fewer glucose density changes than a T-shape stopcock with rubber. Additionally, when the T-shape stopcock connecting position was at the same point, the glucose density was stable. When the syringe exchange was primed with 4ml and the relay method employed to a patient, the average blood pressure of the patient did not change significantly before and after the exchange. We conclude that the 4ml priming in addition to the relay method was shown to be a safe catecholamine syringe exchange method.

Currently, team approach to health care is promoted, and peripheral IV catheter insertions (IV insertions) by nurses are included in the scope of nurses' work from the point of view of smooth medical treatment and patient service. At the A Center, along with the increased amount of work of doctors and nurses, not only doctors but also nurses have voiced strong demand for the insertion of IV catheters by nurses. To meet their needs, we started to train nurses as the intravenous injection nurses (IV nurses) in 2011. Nurses who have acquired the knowledge and received technical education, and are qualified in the A Center are then permitted to perform IV injections include IV insertions.

By the end of 2014, a total of 478 nurses were qualified as IV nurses and it constituted 66.2% of all nurses. In 2013, we further trained specialized IV nurses and qualified 13 contra media, 18 chemotherapy, and 5 preoperative autologous blood donation IV nurses. They performed a total of 15,332 IV insertions in 2014. The most common purposes of IV insertions were for contra media：6,284 cases, and replacement：4,986 cases. Due to this training program in which nurses can be stepped up, we obtained excellent result. In addition, those achievements led to their confidence and pride, and they were motivated. The training program has also become the driving force in the promotions of their activities.

The purpose of this study was to explore the relationship between the discharge planning ability and the nursing care ability of ward nurses working at a university hospital.

A self-administered questionnaire was given to 196 ward nurses related to the adjustment of leaving the hospital working in the university hospital. The nursing ability consisted of seven competencies. Correlation coefficient between discharge planning ability and the nursing care ability and its seven components were calculated. Discharge planning ability was considered to be an explanatory variable and a multiple regression analysis with the seven competencies of the nursing care ability as the independent variables were performed.

Of the 196 ward nurses contacted, there were 150 valid respondents. Discharge planning ability was positively correlated with nursing care ability (r＝0.379, p＜0.01) and its seven competencies (r＝0.236〜0.538, p＜0.01). Through the multiple regression analysis with discharge planning ability as the predictor variable, only the care coordination was extracted from the seven competencies of the nursing care ability.

Nursing care ability is a part of discharge planning, and discharge planning ability had a positive correlation with nursing care ability. Therefore, improvement in nursing care ability is necessary for improvement in discharge planning ability.

This study aimed to clarify the present conditions and problems of home care support by nurses in integrated community care wards.

Anonymous self-administered questionnaires were distributed to 220 nurses in the integrated community care wards of 10 hospitals in the urban area of the Kanto region.

The home care support in this study was defined as support for returning home and acceptance when disease condition worsened.

The results indicated the item with the highest performance score in nurses' home care support was prompting patients to feed themselves (96.3%), and in prediction after discharge was writing a nursing summary (85.2%). These results clarify the efforts of nurses in integrated community care wards toward improving living functions. The result also provide important insights for home care providers on prediction of medical conditions and lifestyle issues after hospital discharge. Administrators were performing home care support more than the staffs. Those who frequently participated in the pre-discharge conference were also performing home care support in high frequency.

The low implementation of home care support was the utilization of social resources. In order to further implement home care support, skills improvement that can utilize social resources is necessary.

Therefore, it is important for nurses to get support from administrators and to participate in pre-discharge conferences.

This study examined incidents relating to harassment by patients and family members towards nursing staffs. Surveys were distributed to directors and staff of home-visit nursing stations in Prefecture A in Japan, and responses were obtained from 272 individuals at 52 home-visit stations. 32 institutions surveyed did not have instructional manuals relating to harassment. Most staff members had more than 10 years of work experience, however, 95 persons had less than 3 years of work experience at home-visit nursing stations. Furthermore, 105 persons had experienced episodes of harassment within the past year. Large number of respondents experienced “verbal sexual harassment”, “sexual harassment and assault”, and “verbal assault such as intimidation, unreasonable demands, and harassment.” Among the staff that experienced serious harassment, 17 persons scored over 25 points on the Impact of Event Scale (Revised), indicating high risk for post-traumatic stress disorder. Considering the increasing importance in home care in the future, these results suggest that stronger countermeasures are required at home-visit nursing stations to address harassment of nursing staff by patients and family members.

Nanpuh Hospital focuses on cancer medical treatment, and the referral patients of the lung cancer in respiratory medicine are increasing every year. As the doctors in Respiratory Medicine run a busy practice, reduction of doctor's office work is an urgent issue. Lung cancer patients with surgical indications had been referred to the associated University Hospital until this project was started. Currently, respiratory surgeons from the associated University Hospital work under shift-work system that made it possible to perform surgery in our hospital. The electronic medical record in Nanpuh Hospital is different from the one that the respiratory surgeons usually utilize. Furthermore, the unfamiliar systems in the hospital are greater burden to the respiratory surgeons. For this, Medical Doctor's Clark (DC) has supported the operation of medical records and constructed a doctor support system to proceed medical care smoothly. In addition, to strengthen the cooperation between departments of Respiratory Medicine and Respiratory Surgery, DC supported medical care process from diagnosed stage of lung cancer to the phase of the surgery, and to the phase of post-operative management. A questionnaire survey of effect of DC showed that doctors unanimously responded that it leads to cooperation between departments of Respiratory Medicine and Respiratory Surgery. The DC in acute care hospitals is valuable and can contribute to the development of doctors supports.

The aging rate of our country tends to increase every year and exceeds 26% at present. Aspiration pneumonia due to the decline of swallowing function is frequently seen in the elderly. There is a need for feeding therapy in such patients. Kinan Hospital is located in the southernmost tip in Mie prefecture and has a very high aging rate with 37.4% in the local residents. The average age of the internal medicine hospitalized patients is 81 years old. There is a high incidence of aspiration pneumonia. This time, we focused our efforts on team approach involving various professionals to improve the quality of medical care.

Doctors, speech therapists, nurses, dentists and dental hygienists cooperated and intervened in feeding therapy. Feeding therapy is requested to rehabilitation department from the attending doctor or the support nurse. The rehabilitation department estimates swallowing conditions using VE (Videoendoscopic examination) and/or VF (Videofluoroscopic examination). A treatment plan was added to each patient charts；Where oral food intake is possible, ward nurse will take charge of the swallowing therapy with a dentist conducting mouth function training once a week to either patient or ward nurse to propel betterment, for example.

Focusing on the inter-professional understanding and sharing various skills and techniques has transformed hospital care on the whole. As a result, there was a prominent decrease in the frequency of aspiration troubles and improvement was also seen in hospital management.

It is said that the most effective evidence-based therapies for osteoarthritis of the knee (KOA) are patient education, weight loss, and exercise. However, advice from nurses on lifestyle modifications for treating KOA is not popular when compared to similar counseling for treating internal diseases. In August 2011, we launched a team to provide total support for KOA (team TS-KOA), in which nurses from the outpatient department (OPD) tried to take more of a role in patient education for treating KOA. First, we prepared a checklist including risk factors of KOA and made 5 brochures to educate patients about each risk factor. The potential recipients of the education included patients over 40 years old who required knee examination on MRI and patients who underwent total knee arthroplasty. The number of patients who met the requirements from September 2012 to January 2013 were 303. Of these, 91 patients filled out the checklist, and 71 received the guidance of an OPD nurse. A majority of these patients were interested in the education and the OPD nurses felt satisfied with the improvement in patient-nurse relationships. Therefore, we concluded that education of patients with KOA by OPD nurses was an effective approach for both patients and nurses. Further evaluation of the results of this education is needed to improve team TS-KOA's approach.

The diversity of upper and lower limits of psychological vital sign (PVS） were studied in 5 nursing schools. PVS consists of stress self-regulation inventory (SSI), Profile of mood states （POMS）, Monitor-blunter style scale (MBSS), and Stress degree．

365 and 364 students before and after clinical training, respectively, were enrolled in this study. The graph representations of upper and lower limit of PVS in 5 schools tended to be similar in shape that were thought to be possible to standardize PVS. However, when PVS was compared between schools, there were some inventories which were shown as significant difference in SSI, POMS and MBSS. The upper and lower limit of PVS should be established independently considering these diversities. Our next subject is to develop a self-assessment system to make the multilateral and time series grasp of resources, such as mood states, individual psychological response style and resilience of nursing students, possible.

We verified whether psychological vital sign (PVS) was valuable to appraise the mental health of nursing students.

Three subjects who participated in the studies entitled “A trial of standardization of PVS in nursing school” and “Stress management characteristics of nurses as rapport for patients and the development of the coping technique to adopt to the stress” and who left their job in B medical center were enrolled in this study.

The first subject represented high point in human relationship, confidence and steady self-esteem and diagnosed as psychological stabilization.

The second subject was diagnosed as psychological insufficiency and was presumed the possibility of psychological treatment, because there was no difference in the level of tension-anxiety, depression-dejection and anger-hostility before and after clinical practice.

The third subject represented low self-esteem, emotional disturbance, and lack of physical and psychological resilience. She was considered to receive an urgent medical intervention.

The possibility that the PVS was a useful diagnostic tool to conclude a personal psychological character and stress coping power was suggested. Our future subject of research is to develop a self-monitoring system of PVS.

To improve nurses' motivation, we performed the “Homeru-Katsudou”, an active praising action for nurses with each other in our hospital, in which the deputy nurses in charge of education played a major role. Taking account for the results of the “Homeru-Katsudou” last year, we conducted the second year “Homeru-Katsudou” based on the slogan that was as follows：Be proactive in creating an attractive workplace, and award yourself with magic words. The aim of this study included 1) creating a good workplace environment, in which we could mutually recognize each other with continuous action of the “Homeru-Katsudou”, and 2) gaining recognition from others through the “Homeru-Katsudou”, leading to an improvement of nurses' motivation. The “Homeru-Katsudou”, using self-management paper and thank you cards of the season, made an improvement of nurses' motivation, particularly in nurses in their twenties. These results indicated that the workplace environment, in which the staffs could recognize each other, made their feelings positive, intensified their self-affirmation, and improved their motivation. We suggest that “Homeru”(praising others) action is necessary for nursing education because it appears identical to recognizing others.