Development of management indicators of nursing for minimizing physical restraints focused on older adult patients hospitalized in acute care settings: A Delphi consensus study.

Nursing management activities are important in influencing staff nurses' action to prevent or withdraw physical restraints. However, limited studies have been conducted empirically to determine the nursing management activities required for minimizing physical restraints. Therefore, there is a need for basic standards of nursing management activities to minimize physical restraints in acute care settings. This study aimed to develop nursing management indicators to minimize physical restraint (MaIN-PR) in hospitalized older adult patients in an acute care setting. It was conducted between June and October 2021 in Japan using a Delphi consensus approach. Fifty nurses working at top or middle management levels or as certified nurse specialists in gerontological nursing enrolled as participants. The potential indicators obtained from the literature review and interviews were organized inductively to develop two types of draft indicators: (1) 35 items for top management and (2) 33 items for middle management. We asked the nursing managers and certified nurse specialists in gerontological nursing to assess the validity of each indicator in three rounds. Of the 50 initial panelists, 12 from top management and 13 from middle management continued till the third round. MaIN-PR contained 35 indicators for top management and 28 indicators for middle management and were classified into the following six metrics: planning, motivating, training, commanding, organizing, and controlling. To the best of our knowledge, the current MaIN-PR are the first set of nursing management indicators for minimizing physical restraint, including perspectives on geriatric nursing in acute care settings. These indicators could guide both top and middle nursing management, thus supporting staff nurses' judgment in minimizing physical restraints to enhance the quality of older adult patient care.

Cross-validity of the end-of-life care management scale via a cross-sectional study.

AIM: To examine the cross-validity of the end-of-life care management scale (EOLCM scale). METHOD: This cross-sectional study used a self-report questionnaire. Participants were care managers who had not participated in a previous study that developed the EOLCM scale. The survey items included participants' demographic information, the EOLCM scale, the number of end-of-life (EOL) cases managed in the last three years, and two concurrent scales, namely the Multidisciplinary Cooperation Behavior Scale for Medical and Nursing Professionals in Home Care and the "MITORI" Care Scale to Evaluate Nursing Care for Patients with End-Stage Cancer and Their Families. "MITORI" means providing care near the dying person. Internal consistency of the EOLCM scale was assessed via Cronbach's alpha. The model's goodness-of-fit was assessed via a confirmatory factor analysis (CFA). Construct validity was determined using the correlation coefficients between the scores of the EOLCM scale and concurrent scales, and the number of EOL cases managed in the last three years. RESULTS: Valid responses were received from 501 care managers. Cronbach's αs were 0.824 and >0.709 for the entire scale and each factor, respectively. The model fit indices for the CFA were goodness-of-fit index = 0.916, adjusted goodness-of-fit index = 0.892, comparative fit index = 0.947, and root mean square error of approximation = 0.053. Correlation coefficients between the concurrent scales and the EOLCM scale, and between the number of EOL cases and the EOLCM scale ranged from 0.623 to 0.817 (P < 0.001) and from 0.103 to 0.244 (P < 0.001), respectively. CONCLUSION: The EOLCM scale showed acceptable cross-validity. Further studies are required to examine its cross-cultural and predictive validities. Geriatr Gerontol Int 2024; 24: 48-52.

End-of-life care management for older adults at home by multidisciplinary professionals in Japan.

Background: Population aging is a global phenomenon, and there is an urgent need to establish community-based integrated care systems for a sustainable society. In particular, the needs of home-dwelling older adults are multifaceted, encompassing areas such as medical care, nursing care, and welfare. Therefore, it is necessary to implement comprehensive care management that utilizes social resources suitable for diverse needs. This study aims to comprehensively describe care management practices by various professionals for home-dwelling older adults in the end-of-life (EOL) period. Methods: This study adopted a qualitative analysis method using conventional content analysis. We conducted semi-structured interviews of 20 multidisciplinary professionals from February to March 2020. Results: Multidisciplinary professionals ensured continuity of care by implementing care management as necessary when providing care to older adults who desired to stay at home until the end. Seven categories of EOL care management practices for home-dwelling older adults by multidisciplinary professionals were generated: (1) support to enable discharge to home; (2) decision-making support that captures the intention of the older adult without missing opportunities; (3) building a team system to realize the desired life and EOL; (4) family support for the entirety of the EOL period, (5) symptom control aimed at the realization of wishes; (6) emotional support for acceptance of the EOL period; (7) spiritual support. Conclusions: Multidisciplinary professionals, including care managers, collaborating in a mutually complementary manner by sharing a comprehensive understanding of care management might prevent knowledge fragmentation and ensure that older adults receive home-based EOL care.

Development of the ward nurses' discharge-oriented dietary support scale for older adult patients in Japan.

AIM: This study aimed to develop a ward nurses' dietary support scale, including physical, psychological, and social background factors in preparation for older adult patients' life after discharge. METHODS: We conducted a cross-sectional study using a self-reported questionnaire. Scale items were created based on a conceptual analysis, and refined by a Delphi survey. In total, 696 nurses across 16 acute care hospitals in Japan were eligible to participate. The questionnaire comprised 51 items that used a five-point Likert-type scale. These items were evaluated using exploratory factor analysis. Reliability was evaluated using Cronbach's alpha and intraclass correlation coefficients (ICC). Pearson's correlation coefficients were calculated to determine concurrent validity, and construct validity was analyzed using confirmatory factor analysis. RESULTS: Altogether, 241 surveys were included in the data analysis; 236 nurses participated in both the test and the retest. The exploratory factor analysis identified 20 items from three factors as follows: "Assessment for healthy eating behavior," "Adjustment of the living environment, including family and caregiver, together with other professions," and "Continual frailty assessment." In the confirmatory factor analysis, the fitness indices supported these results. Cronbach's alpha was 0.932 and ICC was 0.867 for the overall scale. In the concurrent validity, the three factors had a moderate correlation (r = 0.295-0.537, P < .01 and r = 0.254-0.648, P < .01), except for one subscale. CONCLUSIONS: We developed a ward nurses' dietary support scale, including physical, psychological, and social background factors in preparation for older adult patients' life after discharge. Its reliability and validity were confirmed.

Comprehensive end-of-life care practices for older patients with heart failure provided by specialized nurses: a qualitative study.

BACKGROUND: The context of end-of-life care for older heart failure patients with a complex clinical course provided by certified nurse specialists in gerontology (GCNSs) and Certified nurses in chronic heart failure (CNCHFs) is unclear; therefore, this study aims to describe comprehensive nursing practice for older patients with heart failure at their end of life. METHODS: This study adopts a qualitative descriptive design using content analysis. Five GCNSs, and five CNCHFs were interviewed using a web app from January to March 2022. RESULTS: Thirteen categories of nursing practices for older patients with heart failure were generated: (1) Provide thorough acute care by a multidisciplinary team to alleviate dyspnea, (2) Assess psychiatric symptoms and use a suitable environment to perform treatment, (3) Explain the progression of heart failure with the doctor, (4) Build a trusting relationship with the patient and family and implement advance care planning (ACP) early during the patient's recovery, (5) Involve multiple professions to help patients to achieve their desired life, (6) Perform ACP always in collaboration with multiple professionals, (7) Provide lifestyle guidance according to patients' feelings so that they can continue living at home after discharge from the hospital, (8) Provide palliative and acute care in parallel with multiple professions, (9) Achieve end-of-life care at home through multidisciplinary cooperation, (10) Provide basic nursing care to the patient and family until the moment of death, (11) Provide concurrent acute and palliative care as well as psychological support to alleviate physical and mental symptoms, (12) Share the patient's prognosis and future wishes with multiple professionals, and (13) Engage in ACP from early stages, through several conversations with patients and their families. CONCLUSIONS: Specialized nurses provide acute care, palliative care, and psychological support to alleviate physical and mental symptoms throughout the different stages of chronic heart failure. In addition to nursing care by specialized nurses at each stage shown in this study, it is important to initiate ACP early in the end-of-life stage and to provide care for patients with multiple professionals.

Development of an end-of-life care management scale for assessing the care of older adults who wish to spend the end-of-life period at home.

AIM: To develop an end-of-life care management scale to assess care for older adults who wish to remain at home, and examine its reliability and validity. METHODS: An item pool was created based on a literature review, and the 46-item, tentative version of end-of-life care management scale was developed. Next, a cross-sectional survey was conducted with 2583 care managers using a self-reported questionnaire. An exploratory factor analysis was used to evaluate the scale's internal consistency using Cronbach's alpha. Intra-rater reliability was evaluated using the correlation with a repeat test. Construct validity and criterion-related validity were determined using a confirmatory factor analysis, and correlations between this scale and previous scales, respectively. RESULTS: Valid responses were obtained from 477 care managers. Exploratory factor analyses identified 23 items from four factors: "further the teamwork to realize the individual's wishes," "rapid care planning that anticipates changes in the situation," "support to family members preparing for end-of-life care at home" and "support to become familiar with the older adult's views of life, death and suffering." Cronbach's alpha was 0.819 for the entire scale and ≥0.709 for each factor. The intraclass correlation coefficient of the test-retest ranged from 0.756 to 0.863. The correlation coefficients between the previous scales and the entire scale ranged from 0.569 to 0.795 (P < 0.001). CONCLUSIONS: The scale showed acceptable internal consistency and concurrent validity. Care managers' use of this scale might improve quality of care management and fulfil older adults' wishes to remain at home during the end-of-life period. Geriatr Gerontol Int 2023; 23: 131-140.

Risk factors for postoperative delirium and subsyndromal delirium in older patients in the surgical ward: A prospective observational study.

Postoperative delirium (POD) and subsyndromal delirium (SSD) among older patients is a common, serious condition associated with a high incidence of negative outcomes. However, there are few accurate methods for the early detection of POD and SSD in surgical wards. This study aimed to identify risk factors of POD and SSD in older patients who were scheduled for surgery in a surgical ward. This was a prospective observational study. Study participants were older than 65 years, underwent urology surgery, and were hospitalized in the surgical ward between April and September 2019. Delirium symptoms were assessed using the Confusion Assessment Method (CAM) on the preoperative day, the day of surgery, and postoperative days 1-3 by the surgical ward nurses. SSD was defined as the presence of one or more CAM criteria and the absence of a diagnosis of delirium based on the CAM algorithm. Personal characteristics, clinical data, cognitive function, physical functions, laboratory test results, medication use, type of surgery and anesthesia, and use of physical restraint and bed sensor were collected from medical records. Multiple logistic regression analyses were conducted to identify the risk factors for both POD and SSD. A total of 101 participants (mean age 74.9 years) were enrolled; 19 (18.8%) developed POD (n = 4) and SSD (n = 15). The use of bed sensors (odds ratio 10.2, p = .001) was identified as a risk factor for both POD and SSD. Our findings suggest that the use of bed sensors might be related to the development of both POD and SSD among older patients in surgical wards.

The effects of a leaflet-based health guide on health literacy, self-efficacy, and satisfaction among older Japanese-Brazilian adults living in Brazil: A quasi-experimental study.

BACKGROUND: This study assessed the effects of a Japanese leaflet-based health guide for older Japanese-Brazilian adults living in Brazil, on health literacy, self-efficacy, and satisfaction with the health guide and participants' subjective health status. METHODS: The study followed a one-group pretest-posttest design and was set in the Japanese-Brazilian community in South Brazil. The 21 participants were Japanese-Brazilian individuals aged over 65 years, living in Brazil, and able to converse in Japanese. During the annual health checkup of 2016, we provided about 20 min of health guidance in Japanese using our leaflet, which included information about lifestyle-related diseases, recommended salt and sugar intake levels, and graphical charts. Participants' health literacy (HL) was the primary outcome; self-efficacy and satisfaction with the leaflet-based health guide and participants' subjective health status were secondary outcomes. We assessed the effect after completion of the health checkups in 2016 and 2017. Data were analyzed using repeated measures of ANOVA and the Bonferroni multiple comparison test as required. RESULTS: There were no statistical significant differences in HL (functional HL: p-value = 0.22; communicative HL: p-value = 0.17; critical HL: p-value = 0.40; total HL score: p-value = 0.12) and self-efficacy (p-value = 0.28) across the three assessment points. We detected a statistical significant difference in satisfaction with the health guide, post-intervention in 2016 and 2017 (baseline score: 86.7±20.4; post-intervention score in 2016: 92.5±12.2; post-intervention score in 2017: 76.2±21.9; p-value of repeated ANOVA < 0.01, ηp2 = 0.28; p-value of the multiple comparison in 2016 and 2017 = 0.01, 95% CI 4.09-28.51). However, the Bonferroni multiple comparison test did not show pairwise difference during multiple comparisons of participants' satisfaction with their subjective health status (scores: baseline, 69.6±24.2; post-intervention in 2016, 78.5±21.1; post-intervention in 2017, 58.0±31.1; p-value of repeated ANOVA = 0.02, ηp2 = 0.21; p-values of the multiple comparisons> 0.05). Scores of all outcomes, except self-efficacy, increased from baseline to post-intervention in 2016, but declined at post-intervention in 2017. CONCLUSIONS: The leaflet-based intervention appeared to have short-term effects. The findings suggest that direct intervention in older adults' native language may improve their satisfaction when living in non-native countries. TRIAL REGISTRATION: The UMIN-CTR unique registration ID is UMIN000032443 . Retrospectively registered on May 1, 2018, at: https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000036999 .

[Correlates of mental health in Japanese caseworkers employed at social welfare offices].

OBJECTIVES: The aim of this study was to evaluate the correlation between the mental health status of caseworkers at welfare offices and factors affecting mental health (i.e., working conditions, participation in training courses and workshops, lifestyle habits, presence of illness, social support, and self-efficacy). METHODS: The welfare offices in Japan (1,230 locations) were arranged in descending order according to their establishment and region. Systematic sampling was then conducted to select 20% (n =246) of the welfare institutions for this study. A total of 1,230 caseworkers on welfare (five from each institution) were administered anonymous self-completed questionnaires. The questionnaires involved the General Health Questionnaire (GHQ)-28 Japanese version and questions regarding basic attributes, working conditions, social support (i.e., family, friends, superiors, and colleagues), participation in training courses and workshops, presence of illness, lifestyle habits, mental health, and self-efficacy. Subjects were divided into the following 2 groups: low-score group (GHQ-28 score ≤5) and high-score group (GHQ-28 score ≥6). Data were analyzed using a t-test, χ(2) test, and Fisher's exact test. The GHQ-28 high- and low-score groups were considered gender-specific dependent variables due to the sex differences observed in the univariate analysis. Significant variables in the univariate analysis were considered independent variables in the multiple logistic regression analysis (forward stepwise selection). RESULTS: Five hundred and six people (410 male and 96 female) provided valid responses. Most respondents had poor mental health (66%, high-score group; 34%, low-score group). Both men and women who worked ≥10 hours/day had significantly poorer mental health than individuals who worked ≤9 hours/day. Individuals with low self-efficacy had significantly poorer mental health compared to people with high self-efficacy. Men who were able to maintain moderate hours of sleep and received support from colleagues, friends, and family had good mental health. Among women, mental health deteriorated with age. Furthermore, women who devoted most work time to home visit had good mental health. CONCLUSION: The mental health of caseworkers at welfare offices can be improved by reducing overtime work hours, ensuring sufficient hours of sleep for each worker, and fostering supportive communication and self-efficacy in the workplace. Furthermore, sex differences should be considered when assessing the mental health of workers at welfare offices in Japan.

Effects of exercise on the prevention of conditions leading to the need for long-term care.

BACKGROUND: Intervention strategies for 'prevention of conditions leading to the need for long-term care' (prevention of long-term care status) that have physically and mentally proven effects are needed. OBJECTIVE: The aim of this randomized controlled trial was to clarify the physical and psycho-social effects of an exercise program, easily performed at home and in communities using inexpensive equipments for prevention of long-term care status. METHODS: A cluster of 196 participants was randomly assigned to the intervention group that performed the exercise for 8 weeks and the control group. Both groups received tests for physical strength and endurance and interview surveys at baseline and 9 weeks later. The exercise consisted of six types of stretching exercises, six types of muscle strength training, two types of balance training and toe stretching in order to improve ambulatory, balance and stability ability of elderly. The physical aspects of the subjects were assessed by balance assessment, activities of daily living (ADL), timed up-and-go test (TUG), functional reach test (FRT), sit and reach. The psycho-social aspects were assessed by the fall prevention self-efficacy scale (FPSE), instrumental activities of daily living (IADL), degree of houseboundness, and assessment at the end of intervention. RESULTS: The intervention and control groups consisted of 101 and 81 persons at the baseline and 92 and 74 after intervention, respectively. The intervention group showed significantly higher values than the control group after exercise in the FRT, the FPSE and degree of houseboundness. CONCLUSION: This exercise program can promote physical and psycho-social aspects of the health in the elderly, and may reduce the amount of care that the elderly require.

Effects of a foot bath containing green tea polyphenols on interdigital tinea pedis.

BACKGROUND: It has been shown that green tea polyphenols (GTP) can directly kill Trichophyton in vitro; however, there are no published clinical studies that show anti-fungal activity of GTP. OBJECTIVES: To identify the effects of GTP on interdigital tinea pedis in elderly patients. METHOD: Ninety-four patients with interdigital tinea pedis were enrolled and were either given a lukewarm water foot bath containing GTP or placebo treatment. Effects of GTP were assessed based on changes in the size of the affected area, the rate of recurrence, microscopy findings, and overall assessment of skin changes. RESULTS: After 12 weeks of treatment with either GTP or placebo, a significant reduction in the size of the affected area was observed (p<0.001). There were no significant differences between the GTP or placebo groups in the size of the affected area (p=0.638), the recurrence rate (p=0.172), or the microscopy findings (p=1.000). However, the overall assessment demonstrated significant improvements (p=0.010) in the GTP group. CONCLUSIONS: These results show that GTP was effective in improving the symptoms of tinea pedis in comparison to only lukewarm water. Our results suggest that GTP could have anti-fungal activity.

Effect of a home-based simple yoga program in child-care workers: a randomized controlled trial.

OBJECTIVES: This study investigated the effect of a brief, simple, home-based yoga program on body pain and health status in child-care workers. DESIGN: This was a randomized, controlled trial comparing a home-based yoga group and a control group. PARTICIPANTS: The trial comprised 98 healthy female nursery school and kindergarten teachers. INTERVENTIONS: A DVD of a simple home-based yoga program was provided for a period of 2 weeks. OUTCOME MEASURES: The primary outcome measure was the reported change in body pain at 2 weeks (after intervention) and 4 weeks (follow-up). The secondary outcome measure was the 30-item General Health Questionnaire (GHQ30) score and physical function. RESULTS: The 67 yoga group participants reported improved menstrual pain at 4 weeks; menstrual pain was reduced from 57.0 ± 27.8 to 37.8 ± 26.7 in the yoga group, versus 52.4 ± 36.5 to 46.9 ± 32.1 in the control group (change from baseline in the yoga group versus change from baseline in the control group, -15.3 points; p=0.044). The total GHQ30 score and the GHQ subscale scores ("sleep disturbance" and "anxiety and dysphoria") improved significantly at 4 weeks in the yoga group, but not in the control group. In the good-adherence group, low back pain improved during the intervention (p=0.006) and follow-up (p=0.001) periods. Menstrual pain was also improved (p=0.044). No adverse events were observed. CONCLUSIONS: A home-based simple yoga program may improve the health status of child-care workers.

Effect of regular gum chewing on levels of anxiety, mood, and fatigue in healthy young adults.

INTRODUCTION: The effect of regular gum chewing on psychological status is unknown. The purpose of this study was to examine the effect of gum chewing for fourteen days on psychological status and physical and mental fatigue in healthy young adults. METHODS: We assigned 50 volunteers randomly to an intervention group (n = 26) and a control group (n = 24). Participants in the intervention group were requested to chew the gum twice per a day for fourteen days. The volunteers were required to complete a questionnaire related to lifestyle for baseline assessment. The State-Trait Anxiety Inventory (STAI), the Profile of Mood State (POMS), the World Health Organization Quality of Life 26, and assessment of physical and mental fatigue by visual analog scale were used at baseline, 2 weeks (after intervention), and 4 weeks (follow-up). RESULTS: At 2 weeks, the score of state anxiety was significantly lower in the intervention group than the control group. The intervention participants' scores of depression-dejection, fatigue and confusion in POMS were better than the control group scores. Mental fatigue were also relieved after the intervention. At 4 weeks, there were no significant differences between both groups. CONCLUSION: Fourteen days' gum chewing may improve the levels of anxiety, mood and fatigue.

Factors contributing to medical errors and incidents among hospital nurses --nurses' health, quality of life, and workplace predict medical errors and incidents--.

The purpose of this study was to examine the correlation of medical incidents and errors among nurses with factors describing their lifestyle, health, and work environment. We analyzed questionnaires completed by 6,445 female hospital nurses engaged in shift work in Japanese hospitals with general wards of more than 200 beds. Logistic regression analysis indicated that the risk for medical incidents/errors was predicted by being under treatment, absence due to sickness in the past 6 months, workplace, break times during night shift, bodily pain, and role (emotional). These results indicate that to prevent the occurrence of medical incidents/errors, it is necessary to regard current/recent illness, bodily pain, and role (emotional) as a nurse's personal problems and break times during the night shift and workplace as administrative problems.

Retraction: Effects of exercise on the prevention of conditions leading to the need for long-term care.

The paper entitled "Effects of Exercise on the Prevention of Conditions Leading to the Need for Long-term Care" by M. Ohtake et al, which was published online on 2 November 2010, has been withdrawn at the authors' request.

Relationship between educational programs offered at midsize hospitals in Japan and novice nurses' anxiety levels.

BACKGROUND: This article describes training methods for novice nurses in midsize hospitals and examines how preceptorship is related to their anxiety levels. METHODS: Questionnaires were sent to nurse managers in 15 hospitals; completed questionnaires were received from 11 hospitals. Sixty-three novice nurses evaluated the educational programs, and their anxiety levels were determined using the State-Trait Anxiety Inventory. RESULTS: Ten hospitals performed group orientation. Among these, 8 hospitals had a preceptorship program. The novice nurses in hospitals with a preceptorship program reported that preceptorship offered learning opportunities. CONCLUSION: It is important that novice nurses receive appropriate education, which will reduce their anxiety.

Verification of reliability and validity of a Japanese version of the Rathus Assertiveness Schedule.

AIM: To verify the reliability and validity of a Japanese version of the Rathus Assertiveness Schedule in novice nurses to contribute to nursing management. BACKGROUND: An adequate scale is needed to measure the assertiveness and the effect of assertion training for Japanese nurses and to compare them with those in other countries. METHODS: Rathus Assertiveness Schedule was adapted to Japanese with back-translation and its validity was examined in 989 novice nurses. RESULTS: The Japanese version showed a high coefficient of reliability in a split-half reliability test (r=0.76; P<0.01). The coefficient of reliability of Cronbach's alpha was high (r=0.84; P<0.01) indicating high internal consistency. The similarity with the concept of stress coping was shown. We extracted eight principal factors using factor analysis with varimax rotation. Elements of these factors were similar to those of the original Rathus Assertiveness Schedule. CONCLUSION: The Japanese version of Rathus Assertiveness Schedule was verified.

Factors affecting rapid turnover of novice nurses in university hospitals.

Rapid turnover of novice nurses eventually results in a shortage of veteran nurses. This study aimed to clarify the factors affecting rapid turnover of novice nurses in a prospective manner. We carried out an investigation in 20 university hospitals whose directors of nursing service departments accepted our request to cooperate with our research program. These hospitals were selected from all of the 102 university hospitals listed in The Hospital Catalog of Japan. The subjects were 1,203 novice hospital nurses who gave their informed consent for participation in our study. The questionnaires, which dealt with burnout, assertiveness, stressful life events, reality shock, ward assignment preference, transfer preference, job satisfaction (workplace, salary, workload, and overtime), social support and coping mechanisms were completed by 923 novice nurses in June 2003. Then, their turnover was investigated in December 2003. Thirty-seven novice nurses (4.0%) quit during this period. Multiple logistic regression analysis showed that the factors affecting rapid turnover were 1) graduation from vocational nursing schools, 2) dissatisfaction with assignment to a ward contrary to their desire, and 3) no peers for support. Assignment of novice nurses to wards they choose as far as possible, avoidance of assigning novice nurses to wards alone, and establishment of a support system for nurses who graduate from vocational nursing schools seem to be important for preventing rapid turnover of novice nurses.

Effects of introducing a critical path method to standardize treatment and nursing for early discharge from acute psychiatry unit.

This research aimed to examine whether early discharge can be performed by nurses of a ward participating in the process of critical path method supporting with offer and evaluation of standard and efficient medical treatments and nursing cares. In order to enrich the system that performs hospitable medical treatment and nursing cares standardized at the psychiatry acute term and to prevent chronic, critical path method was introduced into the acute term ward, then the investigation for nursing job satisfaction that was important to establish critical path method was conducted. By introducing critical path method, it became possible to assess the patients in standard, and the subject of business or a system became clear towards early discharge. It became possible to tie up this subject to a future improvement. Consequently, as for comparison of the patient who applied the schedule table of critical path method at the first and second term, the latter decreased the average length of hospitalization period significantly. The satisfaction of the task requirement, which was important to maintain systems, was decreased by the introduction of critical path method but the score of autonomy in satisfaction increased significantly by the improvement of usage of critical path method. From these, it was suggested that the introduction of critical path method in the acute-care unit psychiatry had possibility to aim at standardization of treatment and nursing and patients' early discharge from hospitals.