Investigation about survey of state which was the terminology classification of nursing practice, and development of model which was constructed for nursing support system in computerized medical records

2004年，对日本注册的4738家医院进行了检查，以确定护理部门电脑病历(CMR)的传播速度。结果，收集到的明信片总数为2127张。不符合人口标准的受访者被排除在2127人之外，剩下1761人作为本次研究的对象医院。这1761家医院作为主题医院，确定了CMR实施情况。2004年，以50家医院为研究对象，采用访谈法对社区卫生服务中心的护理支持系统进行调查。2005年，我们的研究人员讨论了进一步研究的计划。2006年，使用我们最初的测量方法，对192家医院的303名护士进行了调查，以确定他们对CMR有效性的认识。结果，在CMR中，受试者意识到护理过程中的一部分比论文写作方式更有用。但受试者并没有意识到在CMR中使用的有用性，这需要护士的思维过程。因此，护士的这些思维过程需要在下一步研究中进行考察。采用访谈法对18所医院的47名护士进行问卷调查，了解护士在CMR中的思维过程。在此基础上，构建了CMR的部分护理流程，从整体视角描述患者，促进护士的思维过程。近年来，急性期住院患者增多，住院时间缩短。我们必须结合当前的医疗实际情况来构建CMR。

In 2004, a total of 4,738 hospitals registered in Japan as June 2004 with 100 beds and more were examined to identify the rate of diffusion of computerized medical records (CMR) in a nursing department. As a result, the collected postcards totaled 2,127. Respondents failing to meet the population criteria were excluded from the 2,127, leaving 1,761 as subject hospital for this study. These 1,761 hospitals as subject hospital were identified about CMR implementations status. Also in 2004, 50 hospitals as subject hospital were examined to identify about nursing support system in CMR using interview-methods. In 2005, the plan of further study was discussed among our researchers. In 2006, a total of 303 nurses with 192 hospitals were examined to identify awareness of usefulness about CMR using our original measurements. As a result, subjects were aware of more useful on a part of nursing process in CMR than the paper-writing ways. But subjects were not aware of usefulness on use in CMR which thinking process of nurses was required. Thus, these thinking process of nurses was required to examine next study. So a total of 47 nurses with 18 hospitals were examined to identify their thinking process in CMR using interview-methods. As a result, four categories were founded out about thinking pattern of subjects on nursing process in CMR.Consequently, a part of nursing process in CMR was constructed to describe patients from viewing an holistic perspective and promote the thinking process of nurses. Recently, patients of hospitalization with acute period were increasing and period of hospitalization was shorting. We must construct CMR considering current medical situation actually.