Developing the structured knowledge model to navigate the nurses' thinking process in their professional judgment and action.

Authors have defined the function of the nursing observation as "monitoring the onset and course of health problems" and that of nursing action as "preventing health problems". We have also identified three foci of the nursing observation and nursing action respectively. The foci of nursing observation are: "signs and symptoms related to the diseases", "complications related to the invasive medical procedures such as surgery" and "adverse effects related to the pharmacotherapy". Those of nursing action are: "nursing care to fulfill the needs arising from the diseases and the medical interventions", "nursing care to prevent the complications", and "nursing care to prevent the adverse effects". Finally, we have categorized hospitalized patients' conditions into "pre-surgery", "post-surgery" and "rehabilitative phase" for the surgical patients and "severe", "moderate" and "mild" for non-surgical ones. Using these frameworks, we have developed the structured knowledge model for a number of diseases and medical interventions.

A hospital survey on the utilization of the master file of the standardized nursing practice terminology in Japan.

A common language in nursing facilitates better communication among nurses and other healthcare providers, assuring better nursing care, hence better patient outcomes. As we developed and disseminated the standardized terminology of nursing which provided nurses with a set of terms to describe nursing observations and nursing actions, we run a survey to see how much it was recognized and utilized in actual clinical settings. The result showed that approximately 60% of the respondents were cognizant of our terminology, and again 60% of them were either actually using the terminology or interested in using it in the future. For them, the main purposes of utilizing the terminology were nursing documentation and care planning. Sometimes it was used as an educational tool. This suggests that we should further develop a tool to assist nurses with their documentation and care planning alongside the revision of the terminology itself.

Developing the nursing care plans using the "master file of standardized nursing practice terminology" in Japan.

A common language in nursing facilitates better communication among nurses and healthcare team, assuring better nursing care, hence better patient outcomes. As we developed and disseminated the standardized terminology of nursing which provided nurses with a set of terms to describe nursing observations and nursing actions, we developed a certain number of nursing care plans using the terms in it. The nursing care plans included those for the patients requiring medical (pharmaceutical)/surgical procedures or the patients showing some signs and symptoms. Generally, nurses found that the nursing care plans were useful and flexible enough to allow for the modification according to the needs of each individual patient. In conclusion, the nursing care plans based on the standardized terminology showed its relevance to the clinical settings.

Relationship between nursing workloads and patient safety incidents.

OBJECTIVE: To evaluate the relationship between nursing workloads and patient safety incidents in inpatient wards of a general hospital. METHODS: A retrospective data analysis was conducted involving the internal medicine wards in a teaching hospital in Japan between July 1st and December 31st, 2006. To assess associations between nursing workloads and patient safety incidents, we analyzed the following: the relationships between the level of patients' dependency and the number of incident reports; and the relationships between the presence of accidental falls and the presence of patients transferred from the intensive care unit to the wards. RESULTS: Fifty-five nurses worked on the wards (105 beds). The total number of incidents was 142 over the 184 days of this study. There was a positive trend between the number of incidents and the total patient dependency score. The presence of accidental falls in the wards was associated with the presence of transfers from the intensive care unit to the wards (odds ratio 3.14, 95% confidence interval: 1.48, 6.65). CONCLUSION: Greater nursing workloads may be related to the higher number of patient safety incidents in inpatient wards of hospitals.

The development of the nursing observation master file.

An observation by the nursing, symptom views by the doctor and result of examinations can be said to be terms expressing a patient status. We collected names of nursing observation items and result notation terms in bottom up from real practice. We performed Structuring and standardization of "an observation item name" and "the result notation" with 8 step method. This master transcribes an observation result in 1 to 1 for an observation name. On this account we put it as another item when result notation is different to the same observation name. Collected terms are 1,653 cases with a set of an observation item name and the result notation.

The development of the nursing action master file.

The nursing action master was developed through collecting terms used by the nurses. The nursing action terms were classified in 2 of the basics and specialty. The nursing action master consists of four hierarchical structures. Serial numbers and ID are set in every hierarchy. It started from 2006 to supply the master and it is revised every year. The number of the publication records is 1,053 basic nursing practice standard terms.

The development of method for continuous improvement of master file of the nursing practice terminology.

Nursing Action Master and Nursing Observation Master were released from 2002 to 2008. Two kinds of format, an Excel format and a CSV format file are prepared for maintaining them. Followings were decided as a basic rule of the maintenance: newly addition, revision, deletion, the numbering of the management and a rule of the coding. The master was developed based on it. We do quality assurance for the masters using these rules.

Structural visualization of expert nursing: Cancer pain management.

Nurses' knowledge and making decisions in Cancer Pain Management contribute much to the improvement of cancer patients' QOL. Based on the practice of a expert nurse involved in Cancer Pain Management, we have developed the algorithm, which clarified that nurses implement much of observations or complicated decision-makings in Cancer Pain Manage Hereafter it is a significant challenge to examine its consistency and validity to develop its system.