The purpose of this study was to create an “elevated-position” nursing care program for patients with acute cerebral vascular disease that is based on earlier research, and to perfect that program while testing it in clinical practice and revising it. The study method was as follows : ① Draw-up a flowchart that coordinates the present state of nursing care with judgments by which nurses administer care. ② Conduct a literature review to determine the validity of nursing care and nursing judgments. ③ Create a program based on ① and ②. ④ Test the proposed program and ⑤ revise content based on interviews with clinical nurses, doctors, and physical therapists concerning the program. As a result, based on the test cases of 10 patients, integrity and validity were obtained between all care components of the program and judgment criteria, and a program was developed. The next step is to verify the completed program results.

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　Transportation using a wheelchair is one of the mobility aids that is often used at home, and in medical and nursing care facilities. However, there is no useful standard for wheelchair pushing technique that considers the riding comfort of the wheelchair users. To develop an index of preferable wheelchair pushing techniques for starting and stopping that are applicable to actual assistance work, the present study investigated the influence of various distances for wheelchair acceleration and deceleration on riding comfort. One nurse participated as the helper that pushed a wheelchair. Twelve persons participated as wheelchair users. The helper subject pushed the wheelchair using four starting conditions and five stopping conditions with different distances for acceleration and deceleration, respectively. We measured postural angle, electromyogram (EMG), eye blink frequency, breath frequency, and subjective evaluations of wheelchair users and the speed behavior of the wheelchair. The upper body of the wheelchair users was easily inclined and subjective riding comfort was decreased by starting acceleration less than 1.8m and stopping deceleration less than 1.3m. Furthermore, stopping deceleration less than 1.0 m increased EMG activity of the rectus femoris muscle and respiratory rate. These findings suggested that helpers should use distances greater than 1.8m for acceleration when starting to push and 1.3m for deceleration when stopping the wheelchair in order to keep the wheelchair user comfortable.

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　The video teaching material has two merits. If we study with the video teaching material, we can study repeating the interested and the anxious part whenever we want to study. The video teaching material is economical. The purpose of this study was to evaluate it quantitatively by the muscle activity during changing position and Rate of Perceived Exertion (RPE) after changing position when they watched the video teaching material. The difference of the muscle activity during patient repositioning and subjective fatigue after it was investigated. In the intervention group, the muscle activity of Latissimus dorsi of 13 subjects and Biceps brachii of 11 subjects were reduced by half (p＜0.01，p＜0.05) and Erector spinae of 9 subjects was increased by about 10%. Biceps brachii and RPE the intervention group after watching the video were decreased significantly compared with the control group (p<0.01,p<0.001). The way what the novice caregivers limited muscle use to specific areas rather than using the entire body for changing position was improved and they could do changing position with using body coordination. Moreover, RPE was significantly decreased. We thought that it was possible to image it concrete and easy to imitate because operation was explained with the video in the intervention group. It thought study with the video teaching material to be effective from the point to improve the changing position operation, and to reduce a body load.

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　Nurses conducted whole body physical assessments to carefully examine the elderly. This examination yielded information regarding 1) ear wax plugs, tongue coatings, and other conditions which stemmed from daily habits ; 2) hunched back, joint range of motion limitations, and other limitations caused by aging ; and 3) conditions which may be related to disease and which should be examined or treated. In addition the elderly didn’t notice conditions which may be related to disease. So Nurse provide information of physical examination result to the nurse in facilities and proposed that the nurse observe conditions. From these results, we offered guidance to the elderly such that they could receive consultation, treatment, and improve their daily habits. It makes the opportunity Health care and preventive education for the elderly. In addition, while sharing this information, we also reflected with them on how to continue good practices and improve on others. We found that this yielded psychological changes such as significantly higher “confidence in one’s health” and “positive attitude towards striving for health” . We suggested utility of physical assessments for the elderly.

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