Objective: This study was conducted to clarify influential factor and structures of Clinical Competency (CC) at psychiatric nurses. Method: A mail questionnaire survey was administered to psychiatric nurses in Japan. The questionnaire consisted of CC and influential items and basic attributes inferred from categories obtained from a comparative analysis of behavior event interviews. Results: The questionnaire was distributed to 9,369 nurses, from whom 6,147 (65.6%) responses were collected, of which 5,107 (83.1%) represented valid responses. Factor analysis yielded four CC factors and five influencing factors. Results of a covariance structure analysis revealed that the CC of psychiatric nurses comprised four independent factors, "assessment," "helping practice," "creating a basis for helping," and "use of knowledge from experience," with 12 nursing activities representing the factors. Additionally, CC was found to be influenced by [efforts to improve the nursing competency] expressed in < looking for clues to success >, <useful consciousness of training>, <learning from seniors>, <support systems for growth>, and <useful experience of basic education> (GFI 0.961, AGFI 0.952, RMSEA 0.041).

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The objective of this study was to identify the structure and process of nurse manager support for nurses who were involved in patient adverse events. The participants were 26 nurse managers who experienced supporting such nurses. Semi-structured interviews were conducted to collect relevant data, which was analyzed by the grounded theory approach. The analysis results showed that their support is a process converge on core category of "support of recovering from traumas," which consists of six categories: "concerning to nurse's traumatic experience," "creating an environment that encourages recovery from traumas," "supporting nurses to cope with difficulties," "support of recovering," "finishing support for nurses," and "terminating the support without being convinced." While support from nurse managers plays a part in trauma care, it should be recognized that there is a limitation for nurse managers to provide support if they are involved in unexpected patients events and hurt mentally. This suggests that it is necessary to develop a support system that incorporates resources to support nurse managers.

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The purpose of this research is to clarify what kind of interaction is experienced through playing games with long-term inpatients of psychiatric wards, as well as reflecting on what that means. The researchers did not have it as their purpose to promote playing the game Othello, but only agreed to play Othello as it was requested by the inpatients. As more and more inpatients ended up participating, games of Othello were played continually till the end of the fieldwork. While desiring it, many of the patients were afraid of connecting with others. Games of Othello provided them with the opportunity to approach others. The games turned into a place for interaction and not just playing. One could observe commonality between patients' "problem behaviors" and their style of playing Othello, including "running away from conflicts" or "beating opponents without mercy." Such patterns mirrored their way of life. Patients can recover a connection with others and achieve growth by expressing themselves through game playing and by interacting with people. To support that, nurses need to be able to afford time and energy for playing such games with patients as their legitimate task.

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This study investigated the mental health of mothers according to behavioral changes of their autistic children who start receiving education and training, and investigated the mental health effects on mothers based on their own and their children's attributes. This longitudinal study conducted the first survey when an autistic child started receiving education and training, with subsequent surveys conducted at three months, six months, and nine months. The first survey assessed 32 mothers with autistic children, but 18 mothers participated in the final survey. The 18 mothers were divided into an improved group (n=11) and an unimproved group (n=7) based the children's symptoms. The mental health (positive or negative affect of WHO SUBI: Subjective Well-Being Inventory) of mothers was not influenced by behavioral changes of the autistic children. Mothers who increased subscale "Transcendence" by children with autism began receiving education and training. Furthermore, mothers exhibited increased subscale "Primary group concern" and "General well-being-negative affect" by improvement of the autistic children's symptoms. Nevertheless, no improvement was found in symptoms of children with autism. These findings suggest the importance of various social support measures to provide time for the mother to establish roles of self and others within the family and in the community, and to establish the particular role of a mother with an autistic child.

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This study aimed to shed light on the contents of nursing interventions for reducing the use of seclusion and restraint in psychiatric wards. Semi-structured interviews were conducted with 12 psychiatric ward nurses, each with more than 3 years of experience in psychiatric ward work. A qualitative and inductive approach was used to analyze the data. Results showed that psychiatric ward nurses were involved in getting to know a patient, developing collaborative relations, and promoting patients' awareness of their surroundings. They also had respect for the human rights of the patient, and expanded the possibilities of abolishing the use of seclusion and restraint with other staff members. We believe that respect for the human rights of the patient is most important aspect of all nursing interventions. Thus, nursing care should be delivered on this basis. We believe that for such nursing interventions to be provided easily by nurses with little psychiatric nursing experience, all staff in the hospital should espouse the view of non-enforcement of seclusion and restraint as a routine.

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The purpose of this study was to clarify the appeal of nursing and care work in a chronic psychiatric ward and, specifically, where the appeal lay in performing work in such an environment. A semi-structured interview was conducted with nineteen nurses from a chronic psychiatric ward. A continuous comparative analysis of the interviews was performed by using the Grounded Approach Theory. A characteristic feature of the working environment in a chronic psychiatric ward seemed to be "An area covered with a seemingly stagnant atmosphere." However, having a "role that aided in promoting social rehabilitation" appeared to be a particular point of appeal. By taking on this role, nurses were able to utilize their nursing care abilities in full and perhaps even change the outlook of patients who had "resigned themselves to giving up." Subsequently, an "enthusiasm for the nursing profession" was observed as being a direct result of this interaction and involvement with the patient. The enthusiasm for the nursing profession as acknowledged by nurses working in a chronic psychiatric ward was divided into three categories and ten subcategories. Although the working environment was stated to be a disadvantage at first, the appeal was stated to largely be "patients who do not fit into a particular preconceived framework," the opportunity for "deep interpersonal understanding," and the "ability to feel deeply regarding nursing care for patients with chronic conditions."

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The purpose of this study was to clarify nursing care in the acute care unit and after hospital discharge to prevent rehospitalization of the patients soon after discharge. The subject was 83 patients with mental disorders who were hospitalized in the acute care unit and consented to participation in this study. The kinds of nursing care for the subjects during hospital admission and after hospital discharge were extracted for each disease and qualitatively analyzed. The average age of the patients was 47.4 years old and the time period from onset was 11.5 years. The total past admission period was 4.5 years. The average age of nurses who provided nursing care to the patients was 41.1 years old, with their total nursing care experience of 14.5 years, and psychiatric nursing care experience of 10.2 years on average. <Considering patients' stable living after hospital discharge and activating resources> and <providing safe and secure care at home> were extracted in both schizophrenia and mood disorder patients. It was considered that support for encouraging symptom management and self-care was given to schizophrenia patients, and support for encouraging the recognition of depressive conditions and symptoms, and stress management and self-insight was given to mood disorder patients to prevent rehospitalization soon after hospital discharge. There was no difference in the nursing care given between patients who were rehospitalized within three months after hospital discharge and those who were not. We discussed the results of this study from the viewpoints of the care needed for each patient, symptom management, self-care, adequate crisis intervention and continuing supports by professional team in community.

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In this study of patients with chronic-phase schizophrenia who had resumed a community life, the purpose was to clarify their decision-making process based on their accounts regarding experiences of making choices and decisions to control their symptoms. The study subjects were 9 patients in the latter half of adulthood who had utilized psychiatric day care for more than 1 year. They underwent semi-structured interviews, after which qualitative and inductive analyses were performed on the collected data using a modified grounded theory approach. The decision-making process aimed at establishing community life among patients with chronic-phase schizophrenia comprised 3 aspects: 1) recovering willingness at ease, 2) recognizing self by facing reality, and 3) deciding things by oneself in daily life. Thus, by this process, subjects could recover their willingness by experiencing things with safety and ease through interactions with other people, better recognize themselves by facing reality, and, through becoming more confident, decide things by themselves and set goals in their daily lives, as well as establish humanity with daily efforts.

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Using ratings by nursing staff, we assessed the validity of the Japanese version of the Social Behaviour Schedule (SBS) for patients admitted to a mental hospital for a minimum of one year. Exploratory factor analysis was used to identify the following six factors: "Odd in mixing," "Excess and inappropriate behaviour," "Lower and inappropriate behaviour," "Anti-social behaviour," "Attention-seeking in mixing," and "Depressed and anxious." Cronbach's a coefficient was calculated as 0.88, the range of inter-rater reliability values between two nurses was -0.09≦k≦0.78, the range of test-retest correlation values was 0.43≦r≦0.83, and SBS scores for problem behaviour correlated significantly with the Global Assessment of Functioning (GAF) rating (r = -0.65). The item "Social mixing" was found to be problematic for 52.7% of patients. This scale may therefore indicate difficulties associated with patients admitted to mental hospitals for one year or more. The data support the validity of the SBS by demonstrating the following four aspects: structure; generalizability; external aspect; and consequential aspect. The Japanese version of the SBS for long-stay patients in mental hospitals may allow measurement of unacceptable behaviours in society by nursing staff.

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This study aimed to clarify the process of recognizing patients with suicide attempt by nurses working in the emergency room (ER). The subjects comprised 12 nurses working in the ER with experience in providing nursing care for patients with suicide attempt. Data were collected through a semistructured interview and analyzed by the modified grounded theory approach. Some nurses in the ER had their belief of "wanting to help people who wanted to live" activated by the stimulus of treating patients with suicide attempt and recognized that "patients with suicide attempt were living in another world." When they provided nursing care for such patients, they had "anger and fear towards the patients" and behaved as "nurses who failed to provide sincere care." This process was supported by "an environment that allowed criticizing patients with suicide attempt." However, nurses who had experienced "emotionally involved events" with patients and their relatives recognized that "patients with suicide attempt were living in the same world as theirs" and nurses who had experienced "events where the nurses reflected on themselves calmly" recognized that "patients with suicide attempt deserved nursing care." The process of recognizing patients with suicide attempt by nurses working in the ER was to prevent their own values from being at risk.

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