Work environment for hospital nurses in Japan: The relationships between nurses' perceptions of their work environment and nursing outcomes.

AIM: To investigate nurses' perceptions of their work environment and to investigate the relationships between variables measuring the work environment (WE) and nursing outcomes (NOs ). DESIGN: A 2-year prospective longitudinal survey (2013-2015). METHOD(S): Descriptive statistics of nurse demographics, organizational WE and NOs were calculated by position. The associations between Practice Environment Scale of the Nursing Work Index (PES-NWI) and NOs were examined for each unit. RESULTS: The participants were 2,992 staff nurses, 137 nurse managers (NMs), and 8 chief nursing officers in Phase 1 and 7,849, 371 and 23 in Phase 2, respectively. The higher the job position, the better the WE was rated. The higher the PES-NWI scores, the better the outcomes. Descriptive statistics about organizational WEs and NOs and the statistically significant associations between the two were identified.

Development of a scale measuring the job satisfaction of Japanese hospital nurses.

AIM: This study attempts to develop a scale measuring job satisfaction in Japanese hospital nurses. METHODS: The authors developed items for a new scale measuring job satisfaction and determined the scale's internal and external validity. Based on this analysis, the authors then modified the scale after conducting two surveys. In Survey 1, the scale was tested on 600 nurses from two hospitals and items were selected based on item and factor analyses. In Survey 2, items were further refined based on responses from 800 nurses from four hospitals. Using these responses, the authors determined the reliability and validity of the scale. RESULTS: A 37 item job satisfaction scale was developed through examination of internal and external validity and based on the results of item analysis. Through factor analysis, four factors - "positive emotions toward work", "appropriate support from superiors", "perceived significance in the workplace", and "pleasant working environment" - and 28 items were extracted. The cumulative contribution rate was 43.9%. Cronbach's alpha coefficient was 0.91. The correlations found between sense of satisfaction with work, burnout, and self-esteem supported the scale's concurrent and construct validity. CONCLUSION: The authors were successful in developing a scale measuring hospital nurses' job satisfaction. The surveys conducted using this scale identified factors associated with work achievement and capability development, including "positive emotions toward work" and "perceived significance in the workplace", neither of which have been covered by existing scales.

Factors relating to doctors' desire to change hospitals in Japan.

PURPOSE: This study seeks to investigate doctors' desire to change the hospital where they work to sustain higher quality care. DESIGN/METHODOLOGY/APPROACH: Self-administered questionnaires were sent to doctors in Aichi Prefecture, Japan. Data were analyzed using univariate and logistic regression analysis and recursive partitioning. FINDINGS: Factors related to doctors' desire to change hospitals, according to logistic regression, were interaction between working hours and satisfaction with the hospital, evaluation, local government hospitals versus private ones, small vs large hospitals, ophthalmology versus internal medicine, desire to continue working as a hospital doctor and age. Additionally, working hours were also found to be related, based on recursive partitioning. RESEARCH LIMITATIONS/IMPLICATIONS: The response rate was low and sampling bias was observed--therefore results need careful interpretation. Also, because this was a cross-sectional study, causal relationships could not be identified. Desire to change hospitals, but not actual behavior, was measured. PRACTICAL IMPLICATIONS: Efforts to prevent doctors from changing hospitals should include considering job satisfaction and workload, doctor evaluation methods, support for career progression and organizational management. ORIGINALITY/VALUE: As the hospital doctor shortage in rural areas becomes more serious, exploring doctors' desire to leave their current hospital is meaningful for Japanese hospital managers and hospitals worldwide aiming to provide sustainable and higher quality care.

Computer analysis system of the physician-patient consultation process.

PURPOSE: Measurements of the quality of physician-patient communication are important in assessing patient outcomes, but the quality of communication is difficult to quantify. The aim of this paper is to develop a computer analysis system for the physician-patient consultation process (CASC), which will use a quantitative method to quantify and analyze communication exchanges between physicians and patients during the consultation process. DESIGN/METHODOLOGY/APPROACH: CASC is based on the concept of narrative-based medicine using a computer-mediated communication (CMC) technique from a cognitive dialog processing system. Effective and ineffective consultation samples from the works of Saito and Kleinman were tested with CASC in order to establish the validity of CASC for use in clinical practice. After validity was confirmed, three researchers compared their assessments of consultation processes in a physician's office with CASCs. Consultations of 56 migraine patients were recorded with permission, and for this study consultations of 29 patients that included more than 50 words were used. FINDINGS: Transcribed data from the 29 consultations input into CASC resulted in two diagrams of concept structure and concept space to assess the quality of consultation. The concordance rate between the assessments by CASC and the researchers was 75 percent. ORIGINALITY/VALUE: In this study, a computer-based communication analysis system was established that efficiently quantifies the quality of the physician-patient consultation process. The system is promising as an effective tool for evaluating the quality of physician-patient communication in clinical and educational settings.

Value and problems with e-learning materials in relation to patient-nurse communication and assessment in a lecture.

The purpose of this study is to clarify problems with e-learning teaching materials and methods in relation to patient-nurse communication and patient assessment. Students showed high interest in the e-learning materials but evaluated the content of the materials as low. Before using the e-materials only 25 students (26%) were able to have an understanding attitude and communicate effectively and act appropriately in regards to patients' needs; after using e-learning 89 students (92.7%) were able to have an understanding attitude towards patients.

Use of an artificial neural network to localize accessory pathways of Wolff-Parkinson-White syndrome with 12-lead electrocardiogram.

Today, radio-frequency ablation has been shown to be a safe and effective method to treat paroxysmal tachycardia with Wolff-Parkinson-White syndrome. The many criteria reported for localizing the sites of accessory pathways from a 12-lead electrocardiogram have not proven adequate to differentiate the correct sites of accessory pathways for all situations. This study trained an artificial neural network to differentiate the varied features needed to localize 10 sites of accessory pathways. One hundred fifty patients underwent successful catheter ablation, with manifest single and antegradely conducting accessory pathways. Using the two electrocardiogram features of polarity of delta wave and R wave's share of QRS complex, an artificial neural network learned the characteristics of electrocardiogram waves for each site of the 10 accessory pathways through 90 learning cases, and an applicable network model was developed for testing. In 58 of 60 test cases (96.7%), sites of accessory pathways were localized correctly by the network. Based on the method employed in the present study, it thus becomes possible to predict the sites of accessory pathways with Wolff-Parkinson-White syndrome in more detail by using an artificial neural network with a 12-lead electrocardiogram. In the future, when this method is incorporated into a conventional automatic electrocardiogram system which could analyze delta waves and ORS complex, it will become useful to automatically diagnose the locations of the accessory pathways with Wolff-Parkinson-White syndrome in clinical practice.