In this paper we explore what is necessary about how to apply the critical thinking approach in the nursing process.
1) Critical thinking places appropriate emphasis on the nursing process and enables the use of intellectual, interpersonal, and technical skills to succeed in nursing.
2) Thinking is conceptualized into five modes which, collectively, represent the broad definition of critical thinking. The five modes, “Total Recall,” “Habits, ” “ Inquiry, ” “ New Ideas and Creativity, ” and “ Knowing How You Think, ” are explored from both a personal and nursing perspective.
3) This paper provides an expanded view and a case study of how thinking skills, content knowledge, and the nursing process are combined.

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　The K scale is a new instrument used for predicting pressure ulcer risk. We tested the reliability and validity on institutionalized elderly patients. The K scale which we have been developing is composed of two sub scales, the Predisposing Scale and the Trigger Scale. Interrater reliability was used to match the ratios of 10 patients’ K Scale and Braden Scale scores on two different occasions by two different registered nurses. Predictive validity was used to compare the sensitivity and specificity scores in 107 elderly patients using the K Scale and Braden Scale. The matching ratio of the K scale (0.97 ± 0.07) was significantly higher than that of the Braden Scale (0.73 ± 0.14). The recorded sensitivity and specificity values of the Predisposing Scale scores were 88 and 73%, respectively. The Trigger Scale scores were 100 and 91%, respectively. Both K Scale values were higher than the 71% and 49% recorded Braden Scale values. These results indicate the K scale is higher in reliability and validity than the Braden Scale. In this feature study we will evaluate this scale with other population study groups such as rehabilitation and critical patient groups.

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　According to Igaku-Chuo Zassi, eight-hundred & thirty-three clinical reports were recoeded by JAET members between 1988-1998. We divided each into four categories by key word: ostomy care 536 (65%) wound care 152 (18%) continence care 12 (1%), and others 133 (16%). Considering the relative lack of clinical reports related to continence care, we would like to emphasis the importance continence care reporting to promote this field as a specialty within the general study of healthcare for the elderly in Japan. Our CD-ROM reference system is easily accessed by medical staff and other computer users. The importance of JAET members to promote their academic using previous scientific achievements is stressed.

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　The purpose of this study was to consider the shearing force which comes into being when the head of the bed in raised from 0 to 45 degrees and its effect upon pressure ulcers in the para-sacral area. We measured each lord of the horizontal plane and perpendicular direction by using force sensor on healthy adults-2 women and 2 men. We conducted measurements in two ways: raising knees to 15 degrees and at a stationary position.
　By raising up the head of bed, the horizontal plane had an decreasing acute-angled wave in the bed with tearing away from Stationary Friction Force.
　In comparison between raising knees and the stationary position, the stationary cases tended to slide toward the foot of the bed. In the case of raising knees, the lord of the horizontal plane decreased while, the lord of the perpendicular direction increased.
　In conclusion, Fowler’s Position is not good for a person with a high risk of development of pressure ulcers. However, if it should be considered necessary or desirable to raise the head of the bed, the back of the patient should be raised in advance by the nursing staff. We might be able to devise a backrest which could be adjusted to the figure of each individual.

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　This is a report of the results of analysis by using a Self Growth Egogram (following SGE) for 40 ostmates at 5 institutions. The aim of this study is to evaluate how to incorporate our findings to assist with clinical patient instruction at a stoma outpatient clinic.
　Analysis was based on measurement of the mean and standard deviation of each patient’s ego. Based on pattern analysis of SGE deveroped by Ashihara, result were grouped into 3 sections depending on the pitch of each score.
　The SGE mean was CP16.0 ± 2.85, NP14.6 ± 3.93, A12.5 ± 4.38, FC12.1 ± 4.61, AC10.9 ± 3.77.
　CP and AC scores were high relative to patients with lung cancer according to the studies of Tohyama who used same SGE and the mean of healthy people. The NP was a low value. While a a meaningful difference was found in AC depending upon the number of years post-op and the age of each ostomates, no differences were found based on the sex of each ostomates.
　In conclusion, SGE should be carried out at fixed intervals, such as before operation, after operation, before discharge, and after discharge to grasp the psychological state of each patient.

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