Many of these Japanese nurses did not perform at satisfactory levels of diagnostic competency with these two written case studies. Factors that influenced diagnostic competency were length of clinical experience, decision-making responsibility, and frequency of studying nursing diagnosis.

Oncology nurses need to consider the reasons for admission when making nursing diagnoses and interventions for patients with end-stage breast cancer.

Oncology nurses need to consider different cultural backgrounds when offering specific care to patients with terminal cancer. Patients and their families must be educated about the efficacy of narcotics in the care of terminally ill patients with cancer.

Follow-up surveys were conducted in 1982 and 1988 to investigate factors affecting the course of vibration-induced white finger (VWF). Subjects were 353 patients, aged 40 to 70 at the start of the 1982 survey, who were receiving treatment for hand-arm vibration syndrome. Between 1982 and 1988, the attacks of VWF decreased, while numbness and pain in the hand changed slightly. Finger skin temperature showed a tendency to increase, but recovery time in nail compression tests was unchanged. Vibration perception threshold and grasping power tended to become worse. Of the 177 patients with VWF in 1982, 55 (31%) had no VWF in 1988. The improvement in VWF depended on its severity assessed by the frequency of attacks, the extent of the affected finger phalanges and the Stockholm vascular (V) stage at the start of the 1982 survey. The improvement was observed in 46% of the 1V (mild) stage cases, against only 17% of the 3V (severe) stage cases. Patients in the 2V (moderate) and 3V stages had lower finger skin temperature than those without VWF (the 0V stage). Patients with milder VWF seemed more likely to improve. Continued use of vibratory tools was found to be an unfavourable factor for improvement of VWF. Age, smoking and drinking habits, and medical complications showed no significant effects on the course of VWF.

Objectives：To develop a " MITORI"Care Scale that evaluates nursing care for patients with end-stage cancer and their families and to examine its reliability and validity.M ethods：The original" M ITORI"Care Scale was developed based on a descriptive study and a comprehensive review of the literature. A revised 49 -item version was developed based an examination of the content validity of the original scale. Subsequently, the revised questionnaire was distributed to 5 6 2registered nurses employed at 4general hospitals in Japan.Results：Exploratory factor analysis by principal factor analysis with promax rotation was conducted. The following five factors comprised of 22 items were finally extracted：" Care facilitating death without regret,"" Spiritual care,"" Assurance of palliative care,"" Supporting decision making with appropriate information,"and " Arrangement of available care."A confirmatory factor analysis was conducted by analyzing covariance structures and the hypothesized statistical model was found to fit the actual data. The reliability of the scale was confirmed by a Cronbachʼ s alpha internal consistency reliability coefficient of 0.9 1( 0.6 7-0. 83 for subscales) and a test-retest reliability coefficient of 0.7 4. The criterion-related validity was confirmed by interventions using Family Support and Dying Care, the Scale of the Professional Autonomy in Nursing, and the Satisfaction Scale of Hospice Nurses in Providing End-of-Life Care. Furthermore, the construct validity was confirmed by the known-group technique.Conclusion：The above findings indicate that the " M ITORI"Care Scale is sufficiently valid to improve the quality of nursing care for patients with end-stage cancer and their families.