Coping is a complex process.
A review of the literature focused on a theory of stress and coping. According to Lazarus and Folkman (1984), the theory identifies two processes, cognitive appraisal and coping, as critical mediators of stressful person-environment relations, and problem-focused and emotion-focused coping strategies affect patients'outcomes.
　No research has been conducted evaluating of coping in patients with ostomy. However, it would seem likely, that the hospitalized patients whose coping strategies were measured in the studies by Jalowiec and others did experienced by ostomy patients, as well as coping strategies employed. Then, it may be that particuler nursing interventions could be developed and tested which facilitate coping appropriate for the individual's resources and perceived threat.

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　The background of Japanese E.T. nurses is analized on JAET's survey, and the Japanese WOCN certificated expert nurses(CEN) is mentioned in the literature. Expert nursing education, that include outlines of St.Luke's International Hospital E.T. school and JNA's WOCN education program, is referred to. Expert nursing education needs to changes such as: I.Nurses entering the field of WOCN certificated expert nurses will be required to possess baccalaureate degree. 2.In order to grow as a speciality and gain recognition in professional circles, more techunique and knowledge has to be added to JNA's WOCN education program. 3.E.T. nurses need brush-up training. Professional scientific activity should be more active with the view of renewal CEN certification every 5years.

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Purpose: This study was undertaken to assess surgical procedures and basic considerations for stoma creating surgery. It is well known that the better stoma is are important for the better rehabilitation of ostomates.
Methods: Certain requirements in creating the end sigmoid colostomy had been described by Turnbull in 1967. These requirements were verified in this study.
Results: One of the requirements, he described that the viability of the end of the colon must be demonstrated. The viability must be assessed subjectively by surgeon. The pulsation of the margimal artery should be demonstrated. Ligation of the inferior mesenteric artery at its origin is not preferable. On the case which the high ligation was undertaken, the colon must be cut shorter and the stoma site must be located in the midline of the abdominal wall.
Conclusions: On usual Miles operation, if possible, the inferior mesenteric artery must be preserved to keep the viability of the stoma. If it is not possible, the site of the sigmoid colostomy must be located on the umbilical site.

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The aim of this paper is to describe the historical change of stoma operation, Enterostomal Therapy nursing roles and professional education system in Japan. Japan Association of Enterostomal Therapy Nurses (JAET) formed in 1981 by 7 ET's, now has 120 active members in June 1997, who are hospital nurses, employees of companies, nursing school teachers, owners of ostomy centers and part time workers. In 1996, Japanese Nursing Association started Professional Regulation of Certificated WOC Nurse. 78.3% of JAET members wanted the transsition to certified nurse. The background of those change is caused by health care demand and health care reform. Also higher nursing education system raised high standard of Wound, Ostomy and Continence nursing.

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　The purpose of this research is to clarify the perception of many patients that quality of life deteriorates after stoma surgery and also to clarify the factors that infuluence that perception. Accumulating knowledge of both the quality of life perception and the infuluencing factors will assist nurses in providing care to patients undergoing ostomy surgery.
　This perception of a deterioration in quality of life and the factors influencing the perception are clarified throughthe use of the Quantification Method of the Furst Type and Analysis of Variance. In this study stoma surgery was found to increase the patient's “difficulties with living, ” “problems with bowel evacuation,” “discouragement with surgery,” and decrease of “self-esteen.” In addition, the study also showed an increase in the ostomate's “positive attitude toward life” and an increase in the “social support”
　The factors that influence the ostomate's perception of a deterioration in quality of life are sex differentiation, marital status, and academic background.
　Therefore, the results of this reseach seem to suggest that, preoperatively, nurses must carefully plan the care to be provided to a married man whose academic background is a junior high school education.

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　To obtain efficient methods for the prediction of pressure ulcer development in elderly patients, we evaluated the factors that influences the development of pressure ulcer, especially the degree of bony prominence under the sacral region in nursing home patients, aged between 66 to 96. The degree of bony prominence was calculated with two indexes, maximum interface pressure and total interface pressure of the sacral region.
　The development of pressure ulcers significantly correlated with degree of bony prominence. The degree of bony prominence was predicted by the obesity and activity index used in the Braden scale, not by posture and contracture of patients. Using these indexes, we were able the pressure ulcer development with 86% sensitivity, 66% specificity.
　Our results suggested that measurement of total interface pressure is necessary for estimating the degree of bony prominence. This index was influenced by the nutrition state and atrophy of the muscular tissue in the sacral region due to low physical activity. Furthermore, this research demonstrated that the assessment of degree of bony prominence could be a useful clinical method for prediction of pressure ulcer development.

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　In stomal management, using a convex appliance may contribute to the better adherence to peristomal skin, which means longer wear time. However, if these convex appliances were used inappropriately, convexity may be rather causing peristomal skin trouble.
　This time, I had patients who developed stage I pressure ulcers in the peristomal plane because of the inappropriate use of convexity in the outpatient clinic, and therefore I considered the significance of using convex appliance in a selected manner. In selecting the applian , they were classified as shallow, moderate and deep by the degree of convexity.
　The result shows that when convex material is selected and applied, it isimportant to consider the following:
　　①Convexity should be used properly by the degree.(shallow, moderate, deep).
　　②Convex appliance is not necessarily indicated for all patients with flash stoma, but abdominal characteristics and muscle tone must be considered.
　　③A long-term follow-up is needed to manage the change of stoma or peristomal plane characteristics accompanying the patien't weight loss or gain.

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　Management of patients with fistulas is a complex procedure. The researchers attempt to create a guide line for a standard fistula management. In this research, we focused on pri-fistula skin trouble for assessment. The result of assessment; per-fistula skin trouble and pouching procedure indicated the following issues.
　When peri-fistula skin was ulcerated, applying Hydrocolloid dressing as a primary dressing, and skin barrier flange with Convex insert as a secondary dressing led collection of effuluent and epithelialization certain.
　When peri-fistula skin erosion occurred usage of Hydrocolloid or Hydorofilm dressing as a first dressing, usage of one-piece pouch with skin barrier as the second dressing showed the same result.
　Applying a pouching system with proper dressings led to improve the patients'“Quality of Life”.

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