This study has two purposes. The one is to reveal the change on the independent actions of participants, who collaborate with researcher to improve the working environment for the mental health promotion. Another purpose is to analyze the occupational health nursing practice that promotes this change. The target subjects were four fresh system engineers working for an information technology (IT) company. Based on the Soft System Methodology(SSM), the researcher and subjects worked together and made the action program for the mental health promotion. Then the program was carried out in their working place. The change in participants' independent behavior was assessed using the copying scale and the interview. Moreover, the field notes were analyzed to reveal the nursing practices of the researcher. As the result, it was found that the independent actions such as consulting with their superiors or seniors were increased. According to the qualitative analysis, 5 sections and 32 contents of nursing practice were extracted: "do not make villain", "communicate with own real intention", "promote to notice", "inspire to master copying" and so on.

View full abstract

This study aims to explore the nature of difficulty in living for patients with schizophrenia after recovery stage and the structure of nursing interventions for them. Three patients with first episode schizophrenia who were living in community were interviewed by focusing on strengthening their ego. The interviews were conducted by three experienced nurses. The length of interview ranged from 17 to 30 months, and the number of interviews for each patient ranged from 15 to 52 sessions. The nature of difficulty in living and the strategies used by interviewers were extracted and categorized from the records they made immediate after each interview session. The difficulty in living was under [the restrictions of every day life] due to [conflict with others] while fighting with [the thoughts bout self with an illness] on [the difficulty in living related to psychopathology]. That also prevented them from feeling self as a certain self, and [the uncertain self] promoted their difficulty in living. Interviewers analyzed what patients said and developed the conversations by utilizing various communication skills. Through this process interviewers realized their own perplexity, limitations and tendencies, and the diverse potential of patients. Patients exhibited changes in their living by experiencing various life experiences through the long-term interaction with interviewers. Interviewers took on a role of [being reflections of patients] by attempting to relive the experiences of them. This role promoted patients' experience, simultaneously it resulted in important factor of ego strengthening.

View full abstract

The purpose of this study is to program and practice the recreation therapy that can be applicable for various groups of the patients with psychiatric disorders who are hospitalized in psychiatric wards and contains therapeutic factors which are practicable by nurse, and to evaluate it from the view point of the patients. The data was collected by conducting the semi-structured interviews with 9 groups of 43 patients who participated in this program and the content analysis was carried out. As a result, 97 items were extracted from 762 codes related to the evaluation of recreation. The categories of <Attitude of administrator>, <Planning> and <Effect> were further extracted from them and each of them was classified into the negative items or positive items. The categories of <Effect> were further classified into the subcategories of <<Physiological effect>>, <<Psychological effect>> or <<Social effect>>. Since the patients responded to <Attitude of administrator> sensitively, <Attitude of administrator> must be improved and evaluated. It was revealed that the patients sometimes hesitated to participate in recreation. Therefore it is necessary to pay attention to alleviation measures for the resistance. The subcategories of <<Physiological effect>> and <<Psychological effect>> were factors necessary for social rehabilitation. The item of <<Social effect>> was the strongest rehabilitation that promotes the interactions with others. It was indicated there are the needs to develop a program with more therapeutic effect and to sophisticate the evaluation items based on the items that were clarified by this study.

View full abstract

The purpose of this study is to establish a feasible methodology to identify and support victims of domestic violence(DV) in Japan in relation to the role of nursing professionals. In Japan, the majority of DV victims visit hospitals and health centers without recognizing themselves as DV victims. In this study, a check list(CL) for assessing potential DV victims was formulated. Prior to the finalization of the CL, a pre-test was conducted in X prefecture by obtaining voluntary participation of community health nurses and clinical nurses, who are in the front-lines of DV assessment. The contents of the CL were, thereby, finalized taking into consideration the pre-test results and the trial used at the DV Consultation Centre of that prefecture. In this surveillance, among 120 responses from Community Health Nurses, two suspicious cases of DV, including one case of child abuse, were detected.In addition to that, responses given by clinical nurses indicated four DV cases comprising of two women and two elderly individuals. Questionnaire respondents identified some risk factors which were found to be important observation points for detecting DV victims during consultations. Those were domestic financial constraints (40 clients, 74.1%) and malaise and/or depression (34 clients, 63%). Furthermore, violence by husband to child and disorder in a child's daily life pattern (16 clients, 57.1%) were also considered risk factors. As a result of the study, observers perceptions of risk factors were found to be different depending upon the categories of nursing services. It was found to be crucial for the nursing professionals attending the clients to be sensitive to the unnatural or artificial manner of the clients due to their closed attitudes. It is also advisable to maximize the use of the CL with appropriate questioning to allow the clients to relax and be open.

View full abstract

While assistance to help independence of individuals with mental disorders is promoted, the International Classification of Functioning,Disability and Health (ICF), which was released in 2001, proposed that "living in a society" could be recognized from the aspect of functioning. By referring to the ICF, a rating scale for functioning in individuals with mental disorders was created to evaluate these functions. This scale measures the daily functioning of individuals with mental disorders, and consists of activity and participatory aspects. The present study aimed to examine the reliability and validity of the activities aspect of the rating scale for functioning in individuals with mental disorders. Fourteen psychiatric day-care staff evaluated the functioning of 143 psychiatric day-care users. The results showed high reliability of the scale: Pearson's correlation coefficient for the test-retest method was 0.71(p<0.01); and Pearson's correlation coefficient for the split-half method ranged from 0.87 to 0.88(p<0.01). With a Cronbach's reliability coefficient of each factor ranging from 0.72 to 0.85(p<0.01), internal consistency was demonstrated to be high. Factor analysis was conducted for validity and 4 factors were extracted. With a high accumulated proportion in the factor analysis of 63.6%, validity was indicated to be high. The correlation coefficient between evaluation by others and self-evaluation was 0.43, which demonstrates the reliability and validity of the scale.

View full abstract

The purpose of this study is to clarify the characteristics of clinical judgments in the setting the restriction among psychiatric nurses. I had a semi-structured interview with 12 psychiatric nurses who are caring for the patient who has received the restriction. As a result of the analysis, six themes have been extracted. Theme 1: Nurses evaluate stimulation adjustment in order not to make patients unstable in the process of removing restrictions. Theme 2: Nurses always anticipate unexpected accidents when they care for patients who are restricted. Theme 3: Nurses make clinical judgments in order to release patients' stress of restriction. Theme 4: Nurses are concerned about disadvantages and suffering of patients when they are not restricted and make clinical judgments focusing on avoiding them. Theme 5: Nurses estimate trust of patients and make judgments focusing on developing a relationship of mutual trust during their commitment. Theme 6: Nurses intentionally monitor patients and determine the possibility of removing restrictions.

View full abstract

The objective was to clarify what kind of experiences psychiatric mental health nursing teachers have in their interactions with students, addressing both the characteristics of students that affect that experience and how teachers handle their interpersonal relationships. A peer group of the teachers was held a total of 27 times, and the contents of the discussions were qualitatively and inductively analyzed. The study took place over a period of one year and three months, and a total of 84 mental health nursing teachers participated. In the group, a large number of the participants spoke of students with whom they were having difficulties. These students were showing characteristics described as "self-centered," "tending to worry about how they were evaluated by the teacher," and "lacking in empathy." It was thought that repeated damage to the students' narcissism due to traumatic experiences in their past such as a diagnosed mental disorder, shaped the characteristics of the students. Teachers were also hurt by failures to gain the attention of patients, resulting in compassion fatigue, which caused their narcissism to suffer. The introduction of systematic teacher "self-evaluations," the participation of teachers in the competition to get new students, and the existence of feeling rules applied to teachers aggravated this. In discussion, the interaction among the students, patients, and teachers in the clinical practice were analyzed. It became clear that in terms of interpersonal relationship what happened between students and patients were interrelated with what happened between students and teachers.

View full abstract

The purpose of the study is, by focusing on "threat" - the chief constituent of a traumatic experience - to clarify through interviews the kinds of threatening experiences that nurses in psychiatric practice have had, and to consider the modalities of these experiences and their impacts. I performed semi-structured interviews with nine nurses working in psychiatric units, and the data was analyzed qualitatively and inductively. From the results, it was found that the participants felt threatened by "being targeted," "seeing or hearing about an attack on or intimidation toward others," "encountering suicide among patients," "being sexually assaulted," "being exposed to unpleasant sexually suggestive acts or delusions," and "becoming emotionally undermined by patients." These were traumatic experiences, and on such occasions the nurses felt alone and isolated, feeling their identity to be at risk. The experience of psychological victimization as depicted by the participants included secondary traumatic stress that occurs when one assists those who themselves are psychologically hurt. The results suggested that the nurses' anxiety over losing a sense of control may intensify their sense of crisis, leading them to incline more toward isolating or physically restraining patients. To improve the mental health of nurses and, in turn, their care for psychiatric patients, measures should be taken to achieve a better understanding of and recovery from traumatic experiences among nurses.

View full abstract

We conducted semi-structured interviews with seven women who participated in alcoholic anonymous(AA), and studied the relationships among female members and the experiences which made their recovery process difficult. We analyzed qualitatively and inductively those results from the interviews and identified 10 categories. The following three categories were identified as a common women' s recovery experience: (1) the difficulty of recovery for female alcoholics; (2) change in the relationships with family, and in dealing with other people; and (3) ambivalence felt to the female members of the AA group. Female alcoholics, who had ambivalence towards other female members, also showed sympathy to each other, which enabled them to understand better their female sexuality. The experiences they gathered through deepened relationships with other female alcoholics induced a new change in their human relation to them. Our research suggests that the conflict between a woman' s role as a wife and a mother sometimes caused a relapse leading to more alcohol abuse in them and might make their recovery more difficult. But, on the other hand, it enhanced motivation to stop drinking, and suggests that it is a characteristic behavior for them.

View full abstract

The purpose of this study was to elucidate methods of nursing care for psychiatric patients with physical diseases. Data was collected through participant observations while the researcher intervened to provide support for the nurses' care for the psychiatric patients with physical diseases. The data were analyzed qualitatively, focusing on the methods of nursing care. The subjects of the study were four psychiatric patients with physical diseases and the nurses who cared for them. The study found in conclusion that nursing care for psychiatric patients with physical diseases can have the following characteristics; " nursing care to ensure that patients with strong delusions can receive proper physical therapy," "nursing care to encourage independence in patients with mainly negative symptoms," "nursing care to encourage independence in patients with anxiety" and "nursing care for patients with physical symptoms of unknown origin in order to permit the early discovery of abnormalities" As methods of nursing care, "easing stress that accompanies physical treatments," "cooperating with other health care professions" and "observing the patients closely" were common to all four cases, suggesting their importance.

View full abstract

The purpose of this study was to describe subjective experiences of patients with schizophrenia who had known their own illness. We conducted semi-structured interviews with six outpatients in a university hospital. The data were analyzed qualitatively with the following five viewpoints: 1) how they knew their illness, 2) how they felt about their illness, 3) how they coped with the feelings, 4) what they talked about with the family members, and 5) what they wanted nurses to do. Our study indicated that schizophrenia patients experienced a variety of feelings and took their own coping strategies after their knowing the illness. Schizophrenia was renamed at 2002 from "Seishin Bunretsu Byo" to "Togo Shitcho Sho" in Japan in order to reduce the stigma. Nevertheless, most of the patients did not want to disclose their illness at the study point. These results suggest that nurses should understand the patients' surroundings and their own coping strategies and that the nursing practice should be adjusted to levels of their acceptance of the illness.

View full abstract

[in Japanese]

View full abstract