原著

An Investigation into the NursesʼBehavior
with regard to Human Caring in Japan
Mieko Ozawa

M asayuki Mizuno

David R. Evans

Keiko Takeo

National College of Nursing, Japan；1‑2‑1Umezono, Kiyose‑shi, Tokyo, 〒 204‑8575, Japanozawam＠adm.ncn.ac.jp【Abstract】 The purpose of this study is to identify how the concept of Human Caring appears in nursesʼdaily behavior and thento compare two different Asian cultures,Thailand and Japan,to identify the features of Human Caring behavior.The instrumentused in this study was a self‑administered questionnaire developed by the researchers.The Human Caring M eaning Questionnaire(HCMQ)is a questionnaire that consists of 35 items that exemplify the seven elements of human caring.Research in Thailand has
already been carried out, and was reported in this journal in 2002.
The English version of the HCM Q was translated into
Japanese, and pre‑tested by 50 nurses. A reliability coefficient of 0.96 resulted for the HCM Q‑Japanese. The questionnaire wasdisseminated to nurses employed by the government and working at hospitals in Japan.The HCM Q‑Japanese was distributed via
the nurse supervisors of these hospitals to 565 Japanese staff nurses and nurse administrators. There were 544 respondents, a
response rate of 96.3％. The completed questionnaires(526)were used for the data analysis.
There were no statistically significant differences in the means of the total scores when measured according to educational background. However, significant
differences(p＜0.001；ANOVA)were found in regard to work position held,age,and working experience.
In the Thai research,
for technical nurses(graduates from 2‑year programs)the HCMQ score decreases as the nurses get older(p＜0.01；ANOVA).
However,for nurses who graduated from a 4‑year program,the score becomes higher according to age(p＜0.01；ANOVA).In thisJapanese research, there were no technical nurses, and we can see the same tendency as with the Thai 4‑year program in eachcategory.

【Keywords】 human caring, nurse, behavior, questionnaire development, Japanʻ
Human caringʼis an important concept in nursing .

patients can notice as being supported by nursesʼ
. H.

In a clinical setting, human caring is achieved throughSumiya et al. interviewed 12 nurses working at anursesʼdaily behavior towards their patientsʼcare.

psychiatric ward,and made the development of the steps

Some research has been carried out in Japan to find theof caring, clear. They recognized that ʻ
ageʼis a large

effective behaviors of human caring. H. Misao et al.

contributor to the development of caring behavior.

made a questionnaire of 35 concrete behaviors,such as,

However, no research seems to have been done onʻnurses put patients at easeʼ,ʻnurses know how to injectʼ.

nursesʼdaily behavior of human caring and this research

Her team investigated which behaviors are most impor-

is designed to rectify this. We aim to identify how thetant to nurses and patients, and compared the nursesʼ

concept of human caring appears in nursesʼdaily behav-

prioritized behavior with that of the patients.There areior and then to compare two different Asian cultures,some differences in the order of ranking,but almost all

Thailand and Japan, to identify the features of humannurses and patients identifyʻ
caringʼbehaviors as very

caring behavior. These two countries are somewhat

important. J. Kataoka et al. , using a psychologicalsimilar to each other, and different to Western culture.

phenomenological method,did qualitative research on 8

The instrument used in this study was a self‑adminis-

terminally‑ill cancer patients, and identified 16 caring

trated questionnaire developed by the researchers.

behaviors such asʻ
providing excellent careʼ, andWatsonʼs caring concept and Lakomyʼ
s seven themes ofʻ
respecting the patientʼs willʼ. These 16 behaviors were

human caring have been adapted for the questionnairethen categorized into 5 areas, such as, ʻcaring which

as a theoretical base to measure human caring.

makes a relationship of mutual trustʼand ʻ
caring that

Human Caring Meaning Questionnaire(HCMQ)is a

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The

questionnaire that consists of five items for each of

Being satisfied with oneʼs economic status

these seven elements.Consequently,the instrument con-Being friendly to others

sists of the following thirty‑five items：

Having the ability to utilize supportive relationships
with others

１．Essence of person
Finally, these thirty‑five questions were developed

Understanding and loving humanity
Loving others as well as oneself

into a questionnaire using a 5‑point Likert type scale.

Allowing others the freedom to be humanThe higher the score on this scale,the more positive was

Promoting and sustaining the human qualities ofthe perception of the meanings of human caring.

othersUnderstanding the reality and the meaning of life and

The psychometric properties of the HCMQ related todeathvalidity and reliability were assessed.The HCM Q‑Eng-

２．Relationships

lish version was reviewed for content validity testing by

Being comfortable in developing friendship withthree Thai nurse researchers. After revision of theothersinstrument,a pretest was conducted with 15samples andBeing willing to develop companionshipthe reliability coefficient of this instrument was

Being sensitive to the needs of others

0.94(Cronbachʼs alpha).

Providing support to others

Nursing research was then conducted in Thailand. A

Recognizing the uniqueness of others

questionnaire(HCMQ‑Thai)was developed to evaluate

３．Choices

nursesʼbehavior of human caring in Thailand. The

Understanding the values of others

HCMQ‑Thai is written in Thai.There were no statisti-

Providing alternatives to others in their decision‑cally significant differences according to work position,

makingand gender.However,significant differences were foundRespecting the opinions of others

in groups relating to their educational background andRespecting the rights of othersage. Higher education might be effective in influencing

Understanding the desires of others

the performance of actions consistent with human car-

４．Genuine dialogue

ing. These findings are quite interesting. Behaviors

Using warm and kind expressions

consistent with human caring might be increased by

Listening with understanding

education and nursing experience.

Expressing oneself

We would like to know how the Human Caring behav-

Being able to communicate in a humanistic way

iors appear in Thailand and Japan. The purpose of thisShowing willingness to communicate with others

study is to identify the Japanese nursesʼ
behavior with

５．Experiential process

regard to human caring,and to compare the behavior in

Being open to others

these two groups, Thai and Japanese.

Being gentle and tender
Ⅰ．Developing a questionnaire for the investigating

Willingly satisfying the needs of others
Satisfying the extra needs of others

the behavior of human caring in Japan

Being sympathetic to others
６．Healing

To carry out this research in Japan, the English

Using “touch”in a therapeutic way

version of the HCM Q was translated into Japanese.

Believing in faith

Reverse‑translation was not performed,but all elements

Believing in hopeand every item was discussed carefully with the Thai

Being willing to help others without hesitation

researcher.The Japanese language does not fit perfectly

Showing empathy

with these English items,so it was quite difficult work.

７．Human/economic resources exchangeFirst,we translated the English version of the HCM Q

Having a social network

into Japanese, and asked three Japanese expert nurses,

Having supportive exchanges

who are also researchers, to check that they could⎜ 21 ⎜J Nurs Studies N C N J Vol.3 No.1 2004

understand the same items that the researchers had
Ⅲ．Results

intended. It became clear that some of these abstract
items were difficult to recognize easily, and needed
additional explanations. Once we gave additional oral

The sample consisted predominantly of females

explanations, they could understand the abstract items,(95.6％)with the majority of the respondents being staff

but without our additional comment, some statements

nurses(84.2％).The majority of respondents were fromfor the items did not work.For that reason,we decided

three‑year programs(nursing schools, 76.0％, nursing

to divide the 35 items into 7 elements.

junior colleges, 12.9％), 10.3％ held a bachelorʼs degree,Second, the scale of“frequency”was quite problem-and 0.8％ had attended a graduate program in nursing.

atic. ʻAttitudeʼand ʻ
behaviorʼare different. For

The average age and amount of working experience

Japanese nurses,answering questions on theʻattitude ofwere 27.9 years and 6.4 years respectively.

human caringʼis not so difficult, but answering ques-

For all respondents,the mean score for all items wastions about theʻbehavior of Human Caringʼis quite

136.1, which corresponds to a mean score of 3.89 fordifficult. We decided to give 5 points if theyʻdoʼtheeach item. The mean score of the respondents holding

behavior at ʻ
anytimeʼto ʻ
everybodyʼ. Most of Japanese

masterʼs or doctoral degrees was 155.5, equal to 4.44

nurses change their behavior according to the situation,

per item,which indicated that for approximately90％ of

especially when ʻ
at workʼand when ʻ
not at workʼ
. In

the time,nurses performed behaviors consistent with theJapan, ʻ
too much familiarityʼis not a good thing. Whenquestionnaire(see Table 1).

nurses areʻon dutyʼ,they behave to patients or clients in

There were no statistically significant differences ina manner full of human caring, but when they are off

the means of the total scores when measured according

duty,it is not felt to be appropriate behavior to be over‑to educational background. Nurses who hold a masterfamiliar with others. So, we decided to ask nurses toor doctoral degree had the highest score on the question-

mark the frequencyof their dailyactivitywhen at work.

naire(mean＝155.5)followed by the bachelor degree

After making these amendments, the pretest wasgroup(mean＝136.6), with the three‑year program

carried out with 50 staff nurses and nurse administra-group showing the lowest score for carrying out thetors. The reliability coefficient(Cronbachʼs alpha)was

items expressed in the questionnaire(mean＝134.0,

0.96 in the Japanese version of HCMQ(HCMQ‑

136.2).

Japanese).The HCMQ‑Japanese is written in Japanese.

However, significant differences(p＜0.001)were
found in regard to work position, age, and working

Ⅱ．Subjects and Method

experience(see Table 1). Head nurses had the highest
score on the questionnaire(mean＝154.0)followed by

Setting and sample. The target population for thisthe vice‑head nurse group(mean＝141.2),with the staff

study was staff nurses and nurse administrators em-

nurse group having the lowest score(mean＝134.5) (p＜ployed by the government and working at hospitals in

0.001；ANOVA). According to age, the senior groupJapan. Confidentiality was maintained by the question-(41‑55 years old)had the highest score on the question-

naires being completed anonymously and by not using

naire(mean＝151.9)followed by the 31‑40 year old

any form of coding. All the respondents were informedgroup(mean＝137.8), with the youngest group(21‑30

that if the results of the study were published, only

years old)having the lowest score(mean＝134.4) (p＜group data would be revealed.

0.001；ANOVA).According to working experience,theData collection.The HCMQ‑Japanese was distributed

longest serving group(21‑31years)had the highest scorethrough the nurse supervisors of the hospital to 565

on the questionnaire(mean＝153.1)followed by the 11‑

Japanese staff nurses and nurse administrators. There

20 yearsʼgroup(mean＝140.2), and those with the shor-

were 544 respondents, a response rate of 96.3％. The

test period of working experience(1‑10 years)having

completed questionnaires(526)were used for the data

the lowest score(mean＝134.5) (p＜0.001；ANOVA).

analysis.

The relationship between age and the HCMQ scorefor each educational group was then analyzed(see Table
2).For nurses who graduated from a nursing school,the

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Table 1 Summary of the results of the analysis of variances
Source of variation

Mean

Education
Three‑year program
Nursing school

S.D.

N

136.2
(3.89)

17.73

400

Nursing junior college

134.0(3.83)

19.30

68

Four‑year program(Bachelor degree)
Graduate program in Nursing

136.6(3.90)

15.16

54

155.5
(4.44)

16.05

4

Head nurse

134.5
141.2
154.0

17.44
16.56
14.92

443
61
22

Age
21‑30 years old
31‑40 years old
41‑55 years old

134.4
137.8
151.9

17.47
16.68
16.34

397
97
32

Working experience
1‑10 years

134.5

17.31

429

11‑20 years
21‑31 years

140.2
153.1

17.28
16.41

73
24

136.1

17.74

526

Work Position
Staff nurse
Vice head nurse

Total

F

P value

1.96

.119

16.42

＜.001

15.84

＜.001

15.70

＜.001

(3.89)

Table 2 Mean score for HCMQ according to age & educational back‑ground21‑30 years old

31‑40 years old

41‑55 years oldmean±S.D.

mean±S.D.

mean±S.D.

Nursing school

134.2±17.4(n＝284)137.2±16.4(n＝84)

151.9±16.3(n＝32)

Nursing junior college

133.4±19.8(n＝58)
136.6±15.2(n＝54)

137.4±16.8(n＝10)

Bachelor degreescore becomes higher as the nurses get older(p＜0.001；

Significancep＜.001(ANOVA)
p＝0.55(t‑test)

years old)has a mean score of 157.7.

ANOVA). The youngest group(21‑30 years old)has a

When analyzing the 21‑30 year old group only, themean score of 134.2, but the senior group(41‑55 years

HCMQ score rose according to educational background.

old)has a mean score of 151.9.For nurses who graduat-

Nurses who hold a masterʼs or a doctoral degree had theed from a nursing junior college,the score also becomes

highest score on the questionnaire(mean＝150.0)foll-higher according to age. The youngest group(21‑30

owed by the bachelor degree group(mean＝136.6),withyears old)has a mean score of 133.4,and the older groupthe three‑year program groups having the lowest score(31‑40years old)has a mean score of 137.4.This pattern

for carrying out the items expressed in the questionnaire

was also the case for nurses who have a masterʼs or a(mean＝134.2, 133.4). Similarly with the 31‑40 year

doctoral degree. The youngest group(21‑30 years old)

olds, the HCMQ score also rose according to educa-

has a mean score of 150.0, and the older group(31‑40

tional background.Nurses with a masterʼs or a doctoral⎜ 23 ⎜J Nurs Studies N C N J Vol.3 No.1 2004

Table 3 Mean score for HCMQ according to age & work position
21‑30 years‑oldmean±S.D.

31‑40 years‑oldmean±S.D.

41‑55 years‑oldmean±S.D.

134.1±17.5(n＝384)142.8±16.4

136.6±17.6(n＝53)
139.7±15.8140.8±14.9(n＝6)
148.2±22.7(n＝13)(n＝42)(n＝6)

Staff nurse
Vice‑head nurse

Significancep＝0.42(ANOVA)
p＝0.47(ANOVA)

degree had the highest score on the questionnairethe questionnaire were by work position, the head(mean＝157.7), followed by the three‑year program

nurses group；by age, the senior group(41‑55 years

groups(mean＝137.2, 137.4). In Thailand, the membersold)；and by experience the most experienced groupof the mastersʼgroup were comparatively older than the(21‑31 years).

members of other groups.However,in Japan,the age ofWhen analyzing the relationship between age and thethe masterʼs and doctorate group was comparatively

HCMQ score for each educational group(see Table 2),

younger than other group members.

nurses who graduated from a nursing school gained a

When the HCM Q score was analyzed according tohigher score with increased age(p＜0.001；ANOVA).

length of working experience,the results were similar to

For nurses who graduated from a nursing junior college,

age. The HCMQ score increases with more experience.

the score also becomes higher according to age. This

Table 3 shows the relationship between age and thepattern was also the case for nurses who have a masterʼs

HCMQ‑score for work position held(in terms of rank)

or a doctoral degree.These results mean that regardlessand their age.For staff nurses,the score becomes higherof educational background,HCMQ score rose according

as the nurses get older.The youngest group(21‑30years

to age.

old)has a mean score of 134.1,and the senior group(41‑Most staff nurses(86.7％)are under 30 years old and55 years old)has a mean score of 140.8. For vice‑head

the majority(90.9％)of head nurses are over 41 years

nurses,the scores are 142.8(21‑30year olds), 139.7(31‑old. As the score becomes higher according to age, the40 year olds), and 148.2(41‑55 year olds). For headhigher scores of the head nursesʼ
group might be due tonurses, the 31‑40 year old group has a mean score of

the greater age of the members of this group.For staff

130.5, but the senior group(41‑55 years old)has a meannurses, the score also becomes higher as the nurses getscore of 156.4(p＜0.05；t‑test). When only the 41‑55

older(see Table 3). We can see this trend in the headyears old group is considered, the HCM Q score rose

nurse group, but not for the vice‑head nurse group.

according to the work position held. Head nurses had

These results suggest that age(and/or working experi-

the highest score on the questionnaire(mean＝156.4)ence)is related to the HCMQ‑score.As age rises,so thefollowed by the vice‑head nurse group(mean＝148.2),

HCMQ‑score becomes higher. Indou M . suggests thewith the staff nurse group getting the lowest score forsame tendency in her Japanese research.

the items expressed in the questionnaire(mean＝140.8).

Next we considered the work position held and its

Many of the staff nurses(86.7％)are under 30years old.

relationship to the HCMQ‑score.When the 41‑55 year‑

90.9％ of head nurses are over 41 years old.

oldsʼ
scores only are analyzed, the HCMQ score roseaccording to their work position(see Table 3). Head

Ⅳ．Discussion

nurses had the highest score on the questionnaire(mean＝156.4)followed by the vice‑head nurse group

/

/

‑

(mean＝148.2), with the staff nurse group having the

There were no statistically significant differences inlowest score(mean＝140.8).

the means of the total scores when measured according

It is unclear whether age and/or nursing experience

to educational background. However,significant differ-necessarily increase human caring in daily nursing

ences(p＜0.001；ANOVA)were found in regard tobehavior, or whether nurses who have higher positions

work position held, age, and working experience(seeare more stronglyconscious of the importance of human

Table 1). The groups which had the highest scores on

caring behavior.It clear that there is strong relationship

国立看護大学校研究紀要

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between age and working experience that produces richJapan it increased from 134.4 to 151.9. For working

human caring behavior. However it is also possible forexperience, the mean scores of respondents increased

nurses who love nursing and who are full of humanfrom 138.9 to 139.3(Thai), whereas for Japan it in-

caring to survive in the caring situation, regardless ofcreased from 134.5 to 153.1. It looks as though theother factors.

HCMQ‑score rises according to the increasing age andM any researchers such as P.Benner suggest that thethe length of working experience of the nurses. Indoucaring ability develops according to age and/or working

M . pointed out that the factor that most strongly

experience. In Japanese research, several case studies

influences caring in cancer nursing isʻageʼ. This ten-also suggest the same tendency that the caring ability

dency might be stronger for Japanese nurses than Thai

develops according to age and/or working experi-

nurses.

ence

In the Thai research, the mean score of the 4‑year.

Age/experience/position are closely related to anincrease in the HCMQ‑score.

program group was 140.3 and the mean score of themastersʼgroup was 145.4. In this research, the meanscore of 4‑year program group is 136.6 and the mean‑

/doctorate group is 155.5. Evenscore of the mastersʼ

There were no statistically significant differences inthough the Thai members of the mastersʼ
group werethe means of the total scores when measured according

comparatively older(mean＝40.5 years old)than theto educational background.However,nurses who hold amembers of Japanese group(mean＝32.5years old),themasterʼs or a doctoral degree had the highest score onchange of the Thai score is not so different to thethe questionnaire(mean＝155.5)followed by the bache-Japanese research. It seems probable that the HCMQ‑

lor degree group, with the three‑year program group

score rises according to the level of education received.

showing the lowest score for carrying out the items

In the Thai research, for technical nurses(graduates

expressed in the questionnaire(see Table 2).

from 2‑year programs),the score becomes lower as the

When only 21‑30year olds are considered,the HCMQ

nurses get older(p＜0.01；ANOVA). However, forscore rose according to educational background.Nurses

nurses who graduated from a 4‑year program,the score

who hold a masterʼs or doctoral degree had the highest

becomes higher according to age(p＜0.01；ANOVA).

score on the questionnaire followed by the bachelor

In this Japanese research, there were no technicaldegree group. When only the 31‑40 years old group isnurses, and we can see the same tendency as with theconsidered, the HCMQ score also rose according toThai 4‑year program in each category. We cannot be

educational background.Nurses who hold a masterʼs orsure why the tendency(in the Thai 2‑year program)

doctoral degree had the highest score on the question-

happened.

naire(mean＝157.7)followed by the three‑year program
group(mean＝137.2, 137.4).
These results mean that educational background is

When the correlation coefficient is calculated, we

probably related to the HCM Q‑score. However, wefound a higher correlation coefficient between ʻ
eachcannot be totally sure of this,because the population ofitemʼ
and theʻ
total scoreʼ
than the correlation coeffi-

this research is small.To make these relationships clear,cient between the individualʻ
itemsʼ
. We divided the

additional research will be required.

concept of human caring into actions for these 35items,
so it maybe that the concept of human caring is an
integrated concept which is hard to divide into subsets.

In this Japanese research,the mean score for all items

The concept of human caring is quite an abstract notion,

was 136.1, which corresponds to a mean score of 3.89

and it cannot easily be envisaged. However, once it isfor each item.In the Thai research ,the mean score fordefined in terms of actual actions, it is easier to recog-

all items was 139.3,which corresponds to a mean score

nize.

of 3.98 for each item. Both sets of scores are similar.

There are certain limitations to this research.Because

According to age, the mean scores of respondents

the questionnaire is a self‑evaluation tool,it is does notincreased from 138.6 to 139.6 in Thailand, whereas fornecessarily mean that a nurse with a high score is⎜ 25 ⎜J Nurs Studies N C N J Vol.3 No.1 2004

actually doing everything to that degree. It might be2) M isao, H., Hayama, Y., Hishinuma, N., Iwai, I. et al.：that the nurse is saying ʻI am doing enough ʻ
human［A comparative research with regard to caring behaviors
that patients/nurses recognized, Quality Nursing, 3(4),63‑71, 1997. ］ (in Japanese)
3) Kataoka, J., Sato, R.：［Caring of Terminally Cancer

caringʼand do not wish to do moreʼ. Similarly, a nursewith a low score may be saying that they want to do
more human caring, but because of a heavy workload,

Patients,Journal of Japanese Society of Cancer Nursing,13(1), 14‑23, 1999. ］ (in Japanese)4) Sumiya,H.,Okamoto,M.,Aoki,N.et al.：［Development
in Caring Among Psychiatric Nurses, Journal of Kochi
Womenʼ
s University Academy of Nursing, 24(2), 19‑28,

cannot devote as much time to it as she/he would wish.
In interpreting this research it is important to remember
this point. It would be counter‑productive for nurses tosacrifice themselves in order to get a higher HCMQ‑

1999. ］ (in Japanese)
5) Puangrat Boonyanurak, Ozawa, M ., David R. Evans,
Takeo, K.：An investigation into nursesʼbehavior withregard to human caring,J Nurs Studies NCNJ,1(1),11‑
6, 2002.
6) Watson J. (1999) Nursing：Human science and humanscore. By being aware of these 35 items nurses will behelped in putting human caring into practice.
Ⅴ．Conclusion

care：A theory of nursing, M assachusetts：Jones andThis questionnaire was developed to evaluate nursesʼ

Bartlett Publishers.
7) Lakomy, J.M. (1993) The interdisciplinary meaning of

behavior regarding human caring in Japan. There wereno statistically significant differences in the means ofhuman caring, In D.A. Gaut (Ed.)A global agenda forcaring(181‑199 ), NewYork：National League forthe total scores when measured according to educational background.However,significant differences(p＜Nursing Press.
8) Indou, M.：［Research on the caring of the nurses concerned with cancer nursing：Investigation of the factors

0.001；ANOVA)were found in regard to work position
held, age, and working experience. The groups which

which influence caring along with cancer nursing,Journal of Japanese Society of Cancer Nursing, 14(2),42‑53,
2000. ］ (in Japanese)
9) Benner P. (1984) From novice to expert. Excellence andhad the highest scores on the questionnaire were bywork position,the head nurses group；byage,the seniorgroup(41‑55 years old)；and by experience the mostexperienced group(21‑31 years).
■References
1) Watson J. (2002) Assessing and measuring caring inPower in clinical nursing practice.M enlo Park,California：Addison‑Wesley Publishing Company.
10) Takeo, K., Ozawa, M ., M izuno, M. et al.：［Study on

nursing and health science, New York：Springer Publishing Company, 11‑19.

growth of professional competency in nursing and retention of nursing manpower. Report of Grant‑in‑Aid for
Scientific Research(KAKENHI),2001.］ (in Japanese)

日本における看護師のヒューマンケアリング行動に関する研究
小澤三枝子

水野正之
竹尾惠子
David R. Evans
国立看護大学校；〒 204‑8575 東京都清瀬市梅園 1‑2‑1【要旨】「ヒューマンケアリング」の実際を具体的な看護師の行動パターンによって把握すること，および日本とタイにおける行動パターンを比較することを目的として，この調査を行なった。著者らが開発した「ヒューマンケアリング調査票」は 7
要素(35項目)からなる質問紙(HCM Q‑English)である。これを日本語に訳して，HCM Q‑Japanese を作成し，日本の 50
名の看護職を対象に行なったプレテストでは，信頼性係数 0.96を得た。本調査は 1病院で行ない，回収数は 544，回収率は 96.3％であった。そのうち，35の質問項目に完全に回答していた 526を対象に，分析を行なった。看護基礎教育とHCM Q スコアの間には有意な関連はみられなかったが，職位/年齢/臨床経験年数と HCMQ スコアの間には有意な関連があり，職位が上がるほど，また年齢/臨床経験年数が増すほど，HCMQ スコアは有意に高くなっていた(ANOVA，p＜0.001)。 日本の対象者に technical nurse がいなかったことから，どの教育背景においても，年齢や臨床経験が豊かになるほど HCM Q スコアが高くなる傾向にあり，これはタイにおける 4年課程の教育を受けたナースにおける傾向と同じであった。

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