In this study I investigated the intramuscular injection of a sustained release preparation psychiatric patients. My aim was to clarify the incidence of induration and its related factors in order to consider methods for prevention of induration. Induration was confirmed in 11.0% of all cases, 30.0% of the patients developed induration, and induration newly occurred in 10.0% of the patients during the investigation period. The size of the induration ranged from 2×2 cm to 5×7 cm, and its hardness ranged from +7.4 to +12.3 relative to the normal area. By 8 weeks after injection, the induration showed a reduction in both size and hardness. However, because nurses performed injection on the same side, the induration again increased in size. Observation of induration was difficult by thermography but possible using ultrasonography. The factors associated with induration were active degradation, use of haloperidol decanoate, and an insufficient needle implant depth. I thought that induration might be prevented if injection was made deeply into a muscle, and that the muscle at the injection site remained active.

It is said that nurses with caring orientation are more likely to leave their job because of moral distress. The aim of this study is to examine the relationship between moral sensitivity and moral distress on nursing practice among psychiatric nurses.

A self-administered questionnaire consisted of Moral Distress Scale for Psychiatric nurses (MDS-P), Moral Sensitivity Questionnaire (MSQ), and demographics was delivered, and 914 nurses working in psychiatric hospitals responded. Among the three factors of MSQ, the factor “Moral strength” was highly correlated with all the factors of MDS-P; “Unethical conduct by caregivers”, “Low staffing”, and “Acquiescence to patients' rights violations”. As moral strength means ability to sense patients' needs, and to sense when a patient is not receiving good care, nurses who feel more pride to have such ability feel more stress. Years of nursing experience was not correlated with moral distress, which means experience does not improve coping skill to moral issues.

The results suggest that moral distress should not be gotten rid of, but should be served for better care as a guide.

Due to their work with patients, nurses are susceptible to compassion fatigue, making it critical for them to develop the emotional intelligence (EI) needed to gauge the state of their emotional health in the workplace and to deal with emotional exhaustion; so-called compassion fatigue. The aim of this study was to show how senior nurses, who carry the burden of responsibility in wards, can make themselves aware of and express their feelings by talking in groups about their experiences at work. Ten sessions were conducted by three researchers. Seven nurses from different general hospitals who had four years' or more work experience participated. The results revealed that they experience a wide variety of negative feelings, such as fear, helplessness, guilt and anger, which until then they had been unaware of. They also became aware of their own expectations toward and disappointments with their supervisors, and realized they harbored unresolved conflicts, which stemmed from their childhood experiences. The group sessions allowed them to regain confidence in others and in themselves.

The two purposes of this study were to clarify feelings that psychiatric nurses have towards self-injury patients and to clarify the relationship between feelings and emotional attitudes of psychiatric nurses toward self-injury patients.

A questionnaire survey was administered to 363 psychiatric nurses with nursing experience to self-injury patients using two measures, the Feeling Checklist Japanese version (FCJ) and the Nurse Attitude Scale (NAS) short form. The psychiatric nurses were asked to recall self-injury patients and non-self-injury patients that they had treated.

Upon comparison of the self-injury patients group and non-self-injury patients group that psychiatric nurses recalled, there were significant differences in the levels of “reject”, “distance”, “involvement”, and “helpfulness” in the FCJ subscale. From this, it can be seen that taking care of self-injury patients can evoke negative emotions such as anger and anxiety in psychiatric nurses. In addition, psychiatric nurses felt that they themselves are not useful in taking care of self-injury patients. The nurses also felt that they themselves are inappropriate for taking care of self-injury patients.

Furthermore, on multiple regression analysis of the results of the NAS short form in the self-injury patients group, it became clear that feelings that the psychiatric nurses were holding affect their emotional attitudes towards self-injury patients.

Thinking Errors are an important concept in cognitive-behavioral therapy, and are quantified with the widely used Thinking Errors Scale (TES).

The purpose of this study was to examine the construct validity and reliability of the Thinking Errors Scale (TES). Nurses (N=553) working in a hospital were examined to evaluate the validity and reliability of the TES. The survey contents included TES, ATQ-R, and attitude. First, an exploratory factor analysis was conducted for confirmation. Two factors were extracted and named as “belonging to one's self” and “distinguish thinking”. Second, the factor structure in an exploratory factor analysis was confirmed. Third, the factor structure validity of the TES was examined using structural equation modeling. Lastly, to determine the standard related validity of the TES, the relationship between the TES and ATQ-R was analyzed using ATQ-R as an external criterion. The data fit the model, and CFI and RMSEA were 0.970 and 0.047, respectively. The Cronbach's α coefficient of “belonging to one's self” was 0.905, and “distinguish thinking” was 0.853. The validity and reliability of ATQ-R has been previously reported.

Regarding nurses with depression, there may be a need to intervene with problem of “belonging to one's self” and “distinguish thinking” by using cognitive behavioral therapy.

This study was performed to qualitatively and descriptively elucidate the method of pain assessment for patients with psychiatric disorders, and to obtain suggestions for the development of pain assessment methods. We selected nurses with clinical expertise and more than 5 years of experience from the network sampling and administered a semi-structured interview. Upon examination of the data obtained from the provided 29 categories, it was clarified how to assess pain in patients in a responsible and empathetic manner, as nurses of the psychiatry department, how to collect information from patients who had difficulty in expressing their pain, and how to determine the standpoint for the interpretation of information that was appropriate for the characteristics of individual patients with psychiatric disorders, and the causes of their pain. Based on these findings, it was suggested that the accuracy of pain assessment for patients with psychiatric disorders might be improved by understanding the attitudes necessary for pain assessment, learning a multifaceted method to collect information, and learning methods to improve the analytical ability for the causes and symptoms of pain.

Introduction: This study investigated the effects of the social skills of nurses working in super psychiatric facilities. Super psychiatric facilities are designated by the Japanese government as facilities that offer 24-hour emergency treatment for patients with psychiatric disorder. Nurses working in these facilities are known to face extremely high stressors on a daily basis and frequently suffer from burnout.

Purpose: The purpose of this study was to clarify the relationship between social skills and burnout to avoid burnout among nurses working in super psychiatric facilities.

Methods: The cross-sectional study was conducted from May to July 2014 using self-administered questionnaires. A total of 1,251 nurses working in 56 super psychiatric facilities throughout Japan participated in the survey. The self-administered questionnaire used Kikuchi's Scale of Social Skills to measure nurses' social skills and the Japanese version of the Maslach Burnout Inventory to measure degree of burnout. Multiple logistic regression analyses were performed with social skills as independent variable and burnout as dependent variable.

Results: The multiple logistic regression analyses showed that high social skills tended to reduce the risk of burnout.

Conclusions: Social skills appeared to directly and indirectly reduce the risk of burnout among nurses in super psychiatric facilities. Social skills training for nurses working in these facilities may help prevent burnout. Further research is needed to determine the causal relationship between social skills and burnout.

The study aimed to determine the amount of nursing care time allotted to outpatients with mental illness to aid continuous community living, and analyze its relation to the difference in Global Assessment of Functioning (GAF) scores of the patients. Data were collected from 16 nurses from a psychiatric outpatient department regarding their nursing care workload devoted to enable outpatients to continue community living. The nurses recorded the care time, the kind of care, and characteristics of outpatients in 195 cases. The average investigation time was 41.7 hours (SD=13.3). The average GAF score was 59.7. The results showed no difference in the amount of nursing care time for outpatients with a high GAF score and those with a low GAF score. However, in case of outpatients with a low GAF score, nurses spend more time in care aimed at helping the patients achieve mental control than other.