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.

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.

Structural visualization of expert nursing: Expert nursing care for a patient undergoing outpatient radiotherapy.

In the past, almost all patients underwent radiotherapy during the hospital stay. So nurses took care of patients after radiotherapy in the hospital where patients could receive nursing care 24 hours a day. However, recently more and more patients have undergone radiotherapy at clinics as outpatients. This benefits them in enabling them to receive the therapy with improving QOL and maintaining their style of living--on the other hand this requires much self-care ability on their part and patient compliance of outpatient visits depends on their own positive decision-making. Nurses are considered to make decisions or take implementation of various kinds of intervention in the limited time of pre and post proceedings of the therapy when they accommodate patients directly. The process of their intervention has not so far been clarified so that the quality of the care depends on the degree of each individual's capacity or devotion. In addition, with the trend in decreasing hospitalized days, it is predicted that more and more patients will undergo outpatient radiotherapy. So it is significant to clarify the process for quality assurance of nursing.

To realize easy-to-understand description of nursing practice terminology for consumer.

In Japan it is an important issue to introduce Electronic Health Records (EHR) in over 60% of hospitals with more than 400 beds. Introducing E.H.R is supposed to help provide a safe medical environment as well as practice medicine by description in plain terms among professionals and among patients and medical professions. We've developed Nursing Pr Terminology understandable to consumers visualization of nursing action, and arranged them by level and category. However, it is still difficult to express the appropriate contents because they consist of expert decisions and processes. Hereafter, it is a very important challenge of ours to develop an easy-to-understand description of the Nursing Practice Terminology to supply safe and patient-centered medicine to consumers.