The purpose of this paper is to review the research trend in foreign countries related to <patient classification system< which has become a main theme internationally in the medical system, and to examine new patient classification system necessary for the patient value improvement and clinical nursing management as a basis of this operation. As a method, the search for previous studies was conducted mainly by searching for keywords related to patient classification in PubMed and Cinahl-databases, and two journals, Journal of Advanced Nursing and Journal of Nursing Management, were complemented by searching for papers directly related to the keywords. The patient classification system is not the first-generation system aimed only at proper assignment of nurses at the beginning, but the development of the fourth-generation system which includes many elements of hospital management such as cost management of services and medical supplies has been started. As a result of the research, it was shown that the introduction experience of over 10 years of the national level of nursing care intensity evaluation which is rare internationally brings about advantage in the mechanism which collects the evaluation data on the patient disease state which is necessary for the system construction, training on this information collection, retention of the motivation of the provider. Therefore, the development of a disease classification system for fourth-generation patients utilizing this advantage and the realization of clinical nursing management that raises the value of patients based on this system are urgent issues in the future.

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English This study aimed to compare and examine differences in the financial structure between 7 to 1 and 10 to 1 patient-to-nurse staffing ratio hospitals, in calculation methods of the basic management fee for admission in national hospital organizations (7 to 1 hospitals and 10 to 1 hospitals). Of 143 hospitals in national hospital organizations in Japan, 41 hospitals which were notified as 7 to 1 hospitals with an average bed occupancy rate of 80% or more, and 13 hospitals which were notified as 10 to 1 hospitals, were included as subjects in this study (based on notifications in FY 2016).Results showed that, in the balance structure of both the 7 to 1 and the 10 to 1 hospitals, the current profit ratio tended to decrease from FY2015 onwards. Additionally, in terms of their ratios of hospitalization to outpatient treatment, it became clear that the proportion of outpatients increased year on year, and in the cost structure, the materials cost burden, consisting mainly of medical products, was large. In addition, stability indicators showed that quick assets were weak in the current assets. When looking in detail at each item, the salary expenses in the cost structure of the 10 to 1 hospitals were higher than those of the 7 to 1 hospitals. Looking at the reasons for the salary expenses being higher for 10 to 1 hospitals despite 7 to 1 hospitals having higher proportions of nurses, it was found that 10 to 1 hospitals with 300 or fewer beds and a negative current profit ratio had remarkably low quick assets and tended to have an increased personnel cost ratio. In addition, it was assumed that the problems in manpower management and inventory management influenced the operational deficit, based on the relationship between the current profit ratio showing these trends, and the salary expenses plus material expenses.

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This study was aimed at clarifying the awareness in national registered dietitians of nursing care intensity items, and current practice relating to these items, and at examining ways to contribute to the promotion of multi-occupational collaboration. A self-administered questionnaire survey was conducted for 33 national registered dietitians working in four acute care hospitals. Responses were obtained from 25 subjects (response rate, 75.8%). Results showed that ″None″ of all 25 subjects had experience of participating in an in-hospital training course related to nursing care intensity items. Subjects who had ever checked the nursing care intensity evaluation items and information related to these items in nutritional practice numbered 15, and 10 had never checked them. In addition, we looked at whether the evaluation item ″Evaluation form on the severity and the necessity of medical care / nursing I for general ward″ was used in the practice of nutritional care with hospitalized patients, and rated the frequency of use using the 5-point Likert scale. Results showed that patient information utilized for nutritional care included ″status of meal intake assistance″, ″treatment with an antineoplastic agent″, ″presence of a pressure sore″,″presence of radiation treatment″, ″communicability of instructions from staff on medical treatment/ care of the patient″, and other factors. It was suggested that information on nursing care　intensity　items could be used for nutritional management work as well. However, it is necessary to provide education and training related to nursing care intensity items for occupations in which multi-occupational collaboration has not yet been promoted, so that nutritionists use information on nursing care intensity evaluation, and practice hands-on in-hospital care as members of a multi-occupational team.

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The purpose of this study was to investigate nurses' perceptions of physical assessment skills for detecting acute progress of heart failure with time limit in clinical settings. The design of this study was survey research. Research sites were randomly selected from hospitals with 200 or more beds from all over Japan. Finally， the study was conducted at 44 hospitals that agreed to participate. A self-administered questionnaire was developed by the investigator of this study. Forty-eight physical assessment skills were selected for the questionnaire. The results suggest that regardless of the number of years of clinical experience or caring experience for patients with acute progress of heart failure， nurses tend to assess acute progress heart failure patients based on regarding 'necessity' as 'urgency'. Among 33 selected physical assessment items， the physical assessment items chosen by nurses with less than 5 years of clinical experience were similar to those chosen by nurses without experience of taking care of patients with acute progress of heart failure， and were data and items needed in acute phase in general. On the other hand， physical assessment items chosen by nurses with more than 5 years of clinical experience were similar to that chosen by nurses with experience of taking care of patients with acute progress of heart failure， and were direct physical findings specific to heart failure．

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[in Japanese]

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[in Japanese]

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[in Japanese]

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