To understand the reactions and the related processes of nurses who encountered a patient's suicide in psychiatric hospitals, we conducted semi-structured interviews with 10 nurses. The reactions of the nurses were categorized into 14 reactions related to emotion and thought, including "mental shock", "emotional paralysis", "self-accusation", and "feeling of isolation", and four reactions related to the body, including "insomnia". Furthermore, while reactions such as "finding meaning in suicide", "verbalizing feelings", and "reconsidering the nature of nursing" led to behaviors such as "working on efforts to prevent suicide", there were 12 reactions related to behaviors such as "leaving the psychiatric ward/hospital" and "avoiding related thoughts". Moreover, the processes the subjects underwent were broadly classified into: processes presenting aspects in which the mental shock was relieved, such as (1) recovering while receiving support, (2) waiting until their feelings were sorted over time, (4) channeling feelings of self-accusation and isolation into working on efforts to prevent suicide, (6) relearning the nature of mental nursing and working to prevent suicide, and (7) finding meaning in the patient's suicide; and processes presenting aspects in which the mental shock continued and the subject tended to avoid confronting the issue, such as (3) convincing oneself that the cause of the suicide was not related to oneself while remaining subconsciously terrified of suicide and (5) long-lasting mental shock and self-accusation.

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The purpose of this study was to clarify the elements and structure of restrictions as applied to nursing in a psychiatric open ward through the microethnography fieldwork method. The fieldwork identified 19 episodes. Episode analysis revealed five restriction categories: content, reasons, methods, patient responses and method revision. Restriction in a ward means "Actions that maintain patients or patient groups in a stable state." A decision for restriction is often made by a caregiver or family member rather than by the patient and is affected by the sense of responsibility felt by the caregiver or family member toward the patient. The study also revealed that if a patient did not show resistance to restrictions, the restrictions were often irresponsibly repeated.

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[Objective] The purpose of this study was to examine factors and tendencies in the attitudes of nurses caring for suicide attempters in critical care and emergency centers. [Methods] One hundred and sixty critical care and emergency centers were extracted at random. Sixty-three facilities agreed to participate in this study, and 1442 nurses who worked there were the subjects of this study. The instrument consisted of closed-ended questions about what kinds of attitude (feeling, cognitive and action tendency) they have formed toward suicide attempters, making use of Urizaki & Kuwana (2009). This was mailed, and 1255 responses were received. The response rate was 87.0%. The 906 valid responses were analyzed by quantitative methods. [Results] As for factors of attitude, 3 factors were "disapproval of suicidal behavior" (17 items; Cronbach's a=.91), "crisis intervention" (14 items; Cronbach's a=.87) and "concern about patient's prognosis" (17 items; Cronbach's a=.85). Correlation of "disapproval of suicidal behavior" with "crisis intervention" was negative (r=-.33, p<.01), "disapproval of suicidal behavior" with "concern about patient's prognosis" negative (r=-.30, p<.01), and "crisis intervention" with "concern about patient's prognosis" positive (r=.54, p<.01). As for tendencies of attitude, 398 nurses (43.9%) formed an ambivalent attitude, 329 nurses (36.3%) avoidance, and 179 nurses (19.8%) a feeling of closeness. [Discussion] It was suggested that an attitude change in nurses is essential, because a negative attitude of nurses affects both themselves and patients in a bad way. It was suggested that psychological support for nurses is necessary, because many nurses had a conflict over caring for suicide attempters.

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The purpose of this study was to provide a basis for the cognitive behavioral therapy of patients suffering from hallucinations and delusions by using a questionnaire focusing on the cognition, emotion, and coping skills of psychiatric nurses dealing with these patients. First, we selected cognitive, emotional, and coping items from the existing literature and preliminary studies and made a 43-item questionnaire. We then surveyed 161 psychiatric nurses, assessed the survey's reliability and validity, and developed a 33-item questionnaire. Next, we used the new questionnaire to survey 272 psychiatric nurses and compared the factors with their attributes. Four cognitive or emotional factors were extracted, namely: "feeling psychologically threatened," "increasingly feeling that duties impose a burden," "doubt about ability to self-tackle," and "feeling of difficulty with correspondence." Four coping factors were extracted, namely: "positive and collaborative coping," "coping with patients' denial of symptoms," "coping without active listening," "coping with refusal involvement." There was a negative correlation between "increasingly feeling that duties impose a burden" and "positive and collaborative coping." The results differed significantly by gender, career length, and position. The results implied that those who had had long careers and were in managerial positions tended to cope with patients in a positive and collaborative manner. We consider this coping to be similar to cognitive behavioral therapy.

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The purpose of this study was to examine the prevalence of metabolic syndrome (MS) among community dwelling persons with schizophrenia and its relevant factors. Subjects were adults with schizophrenia regularly receiving treatment at A-hospital psychiatric out-patient clinic. Inclusion criteria for participation were: age 18 years or older; disease category F20-F29 based on ICD-10 diagnostic criteria; and able to answer the questionnaire with support. To assess metabolic syndrome status, blood samples and body measurements were obtained at the clinic. Physicians provided information about psychiatric symptoms of a 1-100 point scale based on DSM-IV Japanese version and medications. To assess both daily activities such as those related to housekeeping and physical activity related to exercise. t-test, chisquare test, and multivariate logistic regression analysis were used to describe the results. Statistical analysis was done using SPSS (ver. 15.0). Usable data were provided by 191 men and 144 women (mean 43.8 and 44.6 years). According to the 2005 Japanese diagnostic criteria for MS, it was clinically very significant that MS was more prevalent among community dwelling persons with schizophrenia (22.1%; men 27.2% and women 15.3%) than in the general public in Japan (7.8%; men 12.1% and women 1.7%). Logistic regression analysis with MS as a binary variable identified the following factors as related to MS for the total and the men's sample: high body mass index and smoking; however, washing showed a statistically significant negative association to MS. Among women body mass index was strongly related to MS; however, taking resperidone showed a statistically significant negative association to MS. The data from this study provided evidence that decrease visceral obesity, promote engaging in domestic duties, reduce smoking, and regular monitoring of metabolic risks associated with antipsychotic treatment.

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A purpose of this study is to develop the facilitation discharge scale for long term admitting patient and to evaluate effectiveness of the scale. We extracted the factors on discharge for long term admitting patient from literature review. The scale was constructed by reviewing of existing scales based on extracting factors from a literature review. Then the scale was polished by interview survey and expert panel. The effectiveness of developmental scale was examined by the survey of the necessity and importance for items of the scale and comparing the evaluation of succeed case to not-succeed case on facilitation discharge for long term admitting patient in the mental hospital on Japan.

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The purpose of this study is to clarify the nursing care for patients with schizophrenia who were re-hospitalized by aggravation of symptom within 1 year after discharge. Particularly, this study focused on nursing care which was provided the patients to acquire their symptom management and to establish their community support system. Subjects were 6 nurses who worked at acute care units in 3 psychiatric hospitals. The nurses were interviewed and described nursing care for 6 patients with schizophrenia who were re-hospitalized and discharged within 3 months. The interview data were analyzed qualitatively. As a result of data analysis, 10 categories in nursing care were generated as acquirement of symptom management and 11 categories in nursing care were identified as establishment of community support system. The patients were divided into two groups by the cause of re-hospitalization: the group of medication interruption and the group of stress factor. The number of the patients in each group was three. Compared with two groups, the patients in group of stress factor took more various nursing care than the patients in group of medication interruption. And the patients in group of stress factor were provided nursing care to acquire their symptom management and establish their community support system at early term of re-hospitalization.

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The purposes of this research are to develop a self-evaluation rating sheet on nursing process adopting The International Classification of Functioning, Disability and Health (ICF) as a conceptual framework for psychiatric nursing practicum and to examine its reliability and validity. The sheet was developed and examined through following process. (1) The original sheet with 36 items in formative fashion was developed. (2) The developed original sheet is introduced to psychiatric nursing practicum in "A" university, and filled out by 78 undergraduate students. (3) Answerability, reliability and validity of the original sheet were analyzed by exploration of reasons of NAs and noncommittal answers, Cronbach's alfa, and reexamination of content validation. Findings indicate the necessity of revision of two items. (4) The revised version of the sheet with 37 items was developed. (5) 72 students' answers to revised sheets were analyzed to evaluate the revision. Appropriateness of the revision is indicated by comparing the numbers of NA and noncommittal answer and analysis of variance of each revised item. It is implicated that the self-evaluation sheet developed in this study is valid and reliable to some extent.

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In the present study, we conducted a survey using the Spirituality Rating Scale (SRS) with the objective of elucidating factors that influence the spirituality of patients with mental disorders. Subjects were 153 patients (99 men, 54 women) admitted to one of three psychiatric hospitals. Patients had a mean age of 58.89±11.85 years. The analysis results, SRS-A high scores revealed significant relation for "presence of friends," having roles," "having participation in activities," and "having interests and curiosity." In addition, the results for quantification theory type I showed that the factor affecting the spirituality of patients with mental disorders was "having support," followed by "being interested and curious about recent events," "having hope for one's future," "accepting illness in a positive manner," "having a specific goal," "having roles," and "having friends."

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[Objectives] The study was performed to discuss the roles, required capability, and techniques of the nursing staff by elucidating the importance of individualized psychological education for middle-aged female patients with depression using a booklet. [Methods] This study was a qualitative research investigation comprised of semi-structured interviews regarding the importance of individual psychological education using a booklet for 5 middle-aged female patients with depression who began to sleep away from the hospital. [Results and Discussion] The subjects hoped companions could help them to regain self-confidence for social participation, and they had the opportunity to participate in social activities. Using the booklet, the subjects had the opportunity to review their life style and understand the limits of their physical capacity and mental toughness based on the review. This method was used to enable them to develop their capability to balance their roles and rest in their daily life, based on the findings of the review, and to coexist with their disease. Based on the findings of this study, the roles, capability, and nursing techniques of the nursing staff to provide individual psychological education using a booklet were clarified.

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The present study was intended to clarify the perception of old age and the self-image in future held by the elderly patients of integration dysfunction syndrome under a long-term hospitalization and thereby to obtain suggestions for practicing nursing activities. The subjects were 8 patients of integration dysfunction syndrome over the age of 65 years who were in hospital for more than 10 years in the psychiatric department. The authors conducted the semistructured interview with them, and made a qualitative and inductive analysis. As a result, the perception of old age could be described as "non-attainment of developmental tasks," "psychiatric hospital to become a last home in life," "resignation of unfulfilled desires" and "process approaching to death," while the self-image in future was depicted as "expectation is my spiritual nourishment", "letting a thing take its course," and "lack of the image in future." The reality depicted by those patients experiencing the old age in a long-term hospital life was a psychologically critical situation, in which it was hopeless to resume social life, but it was found that, by compromising on the existing living conditions, they managed to maintain a mental balance. In spite of the situation that there are no prospects for hospital discharge, it is necessary for us to extend the assistance to them so that they may each live a worthy life, satisfying their desires for self-realization as much as possible.

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This study had two purposes. One was to abstract life episodes before the onset from clients' autobiographies. The second purpose was to outline their features. Targeting published autobiographies is a good way to study life episodes because there is no stress for clients and privacy issues. The researcher extracted all sentences related to life episodes before the onset from autobiographies as data. The data were coded and the 138 codes were then categorized into 13 categories. These 13 categories were divided into 6 core concepts which are: 【Pain from personal relationship】 【Distorted understanding/recognition】 【Irrelevant coping methods】 【Difficulty judging situations】 【Barriers in their daily life】 【Creating a mask and hiding behind it】. The results seem to indicate that the core concept 【Difficulty judging situations】 is the most important influence on basic human behavior and is related to the other concepts. The validity of these concepts was confirmed by using the results of other studies.

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Objective: The aim of this study was to gain the suggestion of learning of nursing students that analysis by nursing students' needs in simulation as psychiatric outpatients. Methods: We obtained written reports from 36 nursing students in simulation as psychiatric outpatients and analyzed by framework approach. Results: The eight categories extracted as nursing care for outpatients. These categories were 【warm regards】, 【nursing consultation】, 【assistant of doctor】, 【considering about privacy】, 【reduction of patients in waiting time】, 【production of safety environment】, 【information of medical treatment】 and 【family nursing】. We also gain a category 【assurance】 that of students' needs about attitude of nurse. It was suggested that nursing students reflected about better nursing basis on knowledge and experience in situation of outpatients in this simulation.

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The present study aimed to elucidate the aspects of specific nursing interventions for establishing, maintaining and achieving joint goals with eating disorder patients, in order to suggest effective care. Subjects comprised 11 export nurses working in psychiatric wards. Data were collected using semistructured interviews and analyzed using qualitative induction. Ethical approval was obtained from the Ethics Review Board of the authors' institution. The following three aspects of nursing intervention were extracted: "forming the basic base for mutual goal by supporting the patient," "advance to form joint goals" and "maintaining joint goals." These findings indicate that "nursing intervention to support fundamental patient independence" and "the multilayered process of forming, maintaining and achieving joint goals" are characteristic of these three aspects of nursing intervention for patients with eating disorders.

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