Japanese Psychiatric Nurses Research Articles

Development of a blended learning system for nurses to learn the basics of psychoeducation for patients with mental disorders

BackgroundPsychoeducation should be practiced by various professionals. However, many Japanese psychiatric nurses recognize that psychoeducation should be practiced by other professionals, and show passive attitudes toward learning about evidence-based practices (EBPs), including psychoeducation. We developed a psychoeducation practitioner training program (PPTP) to nurture nurses. However, the PPTP was shown to be ineffective to help nurses achieve psychoeducation skills, although it improved their knowledge of psychoeducation and views on EBP. We developed and evaluated a revised version of the PPTP, integrating blended learning that combines e-learning and group education (BL-PPTP), to nurture nurses’ competencies to practice psychoeducation for patients with mental disorders.MethodWe trained nurses working on acute psychiatric care wards of Japanese hospitals using BL-PPTP, and compared their attitudes for evidence-based practices (EBP attitudes), preparedness for psychoeducational practice, and self-efficacy at 4 points to clarify time-course changes in each participant.ResultsSixty-nine nurses participated, 31 withdrew, and 38 were analyzed. The time needed to complete BL-PPTP ranged from 31 to 259 days, revealing a marked individual difference. There were significant improvements in most participants’ EBP attitudes and preparedness for psychoeducational practice at the end of the program compared with the baseline.ConclusionsBL-PPTP may be useful to nurture nurses’ competencies to practice psychoeducation. BL-PPTP developed in the present study may also help disseminate psychoeducation among nurses, and increase the quality of nursing care.

Structure and predictors of in-hospital nursing care leading to reduction in early readmission among patients with schizophrenia in Japan: A cross-sectional study.

Schizophrenia is a disorder characterized by psychotic relapses. Globally, about 15%-30% of patients with schizophrenia discharged from inpatient psychiatric admissions are readmitted within 90 days due to exacerbation of symptoms that leads to self-harm, harm to others, or self-neglect. The purpose of this study was to investigate the structure and predictors of in-hospital nursing care leading to reduction in early readmission among patients with schizophrenia. A new questionnaire was developed to assess the extent to which respondents delivered in-hospital nursing care leading to reduction in early readmission among patients with schizophrenia. This study adopted a cross-sectional research design. The survey was conducted with the new questionnaires. The participants were registered nurses working in psychiatric wards. Item analyses and exploratory factor analyses were performed using the new questionnaires to investigate the structure of in-hospital nursing care leading to reduction in early readmission. Stepwise regression analyses were conducted to examine the factors predicting in-hospital nursing care leading to reduction in early readmission. Data were collected from 724 registered nurses in Japan. In-hospital nursing care leading to reduction in early readmission was found to consist of five factors: promoting cognitive functioning and self-care, identifying reasons for readmission, establishing cooperative systems within the community, sharing goals about community life, and creating restful spaces. In-hospital nursing care leading to reduction in early readmission was predicted by the following variables: the score on the nursing excellence scale in clinical practice, the score on therapeutic hold, and the participation of community care providers in pre-discharge conferences. Japanese psychiatric nurses provide nursing care based on these five factors leading to reduction in early readmission. Such nursing care would be facilitated by not only nurses' excellence but also nurses' environmental factors, especially the therapeutic climate of the ward and the participation of community care providers in pre-discharge conferences.

Self-compassion and nursing competency among Japanese psychiatric nurses.

This study examined the association of self-focus and self-compassion with nursing competency. Data of 433 psychiatric nurses comprising demographics, other-consciousness, self-compassion, self-focus, and nursing competency were analyzed using the Other-Consciousness Scale (OCS), Self-Compassion Scale (SCS), Japanese version of the Rumination-Reflection Questionnaire (RRQ), and Oriented Problem Solving Behavior (OPSN). Higher internal aspect and lower fantastic aspect in OCS, higher reflection in RRQ, and lower SCS negative subscales predicted a higher OPSN score. The account rate of variance was 12.5%. Psychiatric nursing education should facilitate other-consciousness and reflection enhancement, and assuage uncompassionate attitude towards self.

Factors influencing work engagement among psychiatric nurses in Japan.

To identify the factors influencing work engagement among psychiatric nurses. Work engagement is an essential outcome that promotes nurses' performance, but studies investigating its influencing factors remain limited in psychiatric settings. We hypothesized that job resources and personal resources positively predict psychiatric nurses' work engagement and have a particularly positive impact on engagement when job demand is high. This cross-sectional study included 425 Japanese psychiatric nurses. Data regarding demographics, job resources, personal resources (emotional intelligence), job demand (patients' attitude towards nurses) and work engagement were collected followed by data analysis using hierarchical multiple regression. Reward, supervisor support, nurse-physician collaboration, other-emotion appraisal and use of emotions were positively related to work engagement. Patients' unpleasant attitude towards nurses boosted the association of reward and supervisor support with work engagement. Certain job resources, empathic ability and self-motivation ability may enhance work engagement. Furthermore, reward and supervisor support may be particularly useful when psychiatric nurses face patients' unpleasant attitude. For enhancing psychiatric nurses' work engagement, nursing leaders should educate nurses' skills related to empathy and self-motivation, consider whether nurses are confronted with patients' unpleasant attitude, and improve the job resources.

Association between moral distress and job satisfaction of Japanese psychiatric nurses

Moral distress of psychiatric nurses may affect their job satisfaction or quality of nursing care, thus examination of their moral distress is a significant issue for practice. The purpose of this study was to investigate the level of moral distress and job satisfaction, and association between moral distress and job satisfaction. One hundred and thirty nurses who worked in psychiatric wards in a hospital in Japan completed the Moral Distress Scale for psychiatric nurses (MDS-P) and the Job Satisfaction scale (JS). The MDS-P consisted of subdomains such as “unethical conduct by caregivers,” “low staffing,” and “acquiescence to violations of patients’ rights” in intensity and frequency; the JS consisted of seven subcategories. An institutional review board in the researcher’s college approved this study. Results showed that the “acquiescence to violations of patients’ rights” was the highest of the subdomains of MDS-P, and the “interactions among nurses” was the highest of the subdomains of the JS. The unethical conduct by caregivers (MDS-P) score was negatively correlated with administration (JS) for intensity (r = -.40, p < .001) and frequency (r = .37, p < .001). Moreover “acquiescence to violations of patients’ rights (MDS-P)” was also negatively correlated with the “task requirement (JS)” score for intensity (r = -0.49, p < .001) and for frequency (r = -0.50, p < .001). These results suggest that reduction of moral distress increases job satisfaction particularly for administration and task requirement in nursing care.

Japanese psychiatric nurses’ attitudes toward Evidence-Based Practice: association with needs for learning psychoeducation practices.

Rationale, aims and objectives: To support patients with mental disorders to address appropriate symptom control and preventive measures against relapse, evidence-based practice (EBP), such as psychoeducation, is an important intervention while performing psychiatric pharmacotherapy. However, the use of EBP is likely to have remained passive, as it has been reported being disseminated and implemented slowly. This study explored a classification of psychiatric nurses’ attitudes toward EBP and examined the association between a classification of attitudes toward EBP and needs for learning psychoeducation practices in nursing professionals involved with psychiatric services, with the aim of providing a basis for the dissemination of psychoeducation. Method: A mail questionnaire survey was conducted, involving a total of 194 nurses and assistant nurses working in 13 of the 42 psychiatric hospitals. Analysis was performed using the cluster analysis, chi-square test and one-way analysis of variance. Results: The psychiatric nurses’ attitudes toward EBP were classified into 3 types: experience-oriented challenging, amotivational and rejective and conservative and obedient. Nurses showing amotivational and rejective attitudes accounted for the majority, while those showing experience-oriented challenging attitudes were more aware of the usefulness of psychoeducation and their levels of need for learning related practices were higher on comparison with the others. Conclusions: In order to disseminate psychoeducation among psychiatric hospitals, it may be important to develop interest in psychoeducation, particularly that of nurses showing experience-oriented challenging or conservative and obedient attitudes, with co-operation from nursing managers.

Responses and Results to Ethical Problems by Psychiatric Nurses in Japan

The aim of this study was to investigate the responses of Japanese psychiatric nurses to ethical problems, and the results of those issues. The participants were 130 nurses who worked in psychiatry wards in a hospital. The nurses answered the question “how did you respond when you faced an ethical problem and what results did you get?” in free description. Seven categories were selected qualitatively from their responses: “Lack of action and no change,” “Experiencing problems and feeling gloomy,” “Pointing out misconduct and being hurt,” “Consultation among staff and resolution or not,” “Consultation with physicians and getting positive or negative responses,” and “Searching for and providing evidence-based care,” and “Thinking for themselves.” The facts that some nurses do not cope with ethical problems and some face moral distress without knowing what to do suggest that “improvement of moral efficacy to cope with ethical problems”, “proposing resolution methods”, and “organizational ethics support” may be useful.

Exploratory study of factors influencing job-related stress in Japanese psychiatric nurses.

This study explored the factor structure of psychiatric nurses' job-related stress and examined the specificity of the related stressors using the job stressor scale of the Brief Job Stress Questionnaire (BJSQ). The stressor scale of the BJSQ was administered to 296 nurses and assistant nurses. Answers were examined statistically. Exploratory factor analysis was performed to identify factor structures; two factors (overload and job environment) were valid. Confirmatory factor analysis was conducted to examine the two-factor structure and found 11 items with factor loadings of >0.40 (model 1), 13 items with factor loadings from 0.30 to <0.40 (model 2), and 17 items with factor loadings from 0.20 to <0.30 (model 3) for one factor; model 1 demonstrated the highest goodness of fit. Then, we observed that the two-factor structure (model 1) showed a higher goodness of fit than the original six-factor structure. This differed from subscales based on general workers' job-related stressors, suggesting that the factor structure of psychiatric nurses' job-related stressors is specific. Further steps may be necessary to reduce job-related stress specifically related to overload including attention to many needs of patients and job environment including complex ethical dilemmas in psychiatric nursing.

Patient advocacy

Advocacy is an important role of psychiatric nurses because their patients are ethically, socially, and legally vulnerable. This study of Japanese expert psychiatric nurses' judgments of interventions for patient advocacy will show effective strategies for ethical nursing practice and their relationship with Japanese culture. This article explores Japanese psychiatric nurses' decision to intervene as a patient advocate and examine their ethical, cultural, and social implications. Using semi-structured interviews verbatim, themes of the problems that required interventions were inductively summarized by a qualitative analysis and their contexts and nursing judgments were examined. The participants were 21 nurses with 5 or more years of experience in psychiatric nursing. The research was approved by Institutional Review Board of research site and study facilities. The participants gave written informed consent. Analysis of 45 cases showed that nurses decided to intervene when (a) surrounding people's opinions impeded patients' safety, (b) healthcare professionals' policies impeded patients' decision-making, (c) own violent behaviors impeded treatment and welfare services for patients, (d) own or families' low acceptance of illness impeded patients' self-actualization, (e) inappropriate treatment or care impeded patients' liberty, and (f) their families abused patients' property. To solve conflicts between patients and their surrounding people, the nurses sought reconciliation between them, which is in accordance with Japanese cultural norms respecting harmony. When necessary, however, they protected patients' rights against cultural norms. Therefore, their judgments cannot be explained by cultural norms alone. The findings indicate that the nurses' judgments were based on respect for patients' rights apart from cultural norms, and they first sought solutions fitting the cultural norms before other solutions. This seems to be an ethical, effective strategy if advocates know the culture in depth.

Differences in job stress experienced by female and male Japanese psychiatric nurses.

In psychiatric nursing, female nurses tend to spend more time building rapport with patients and developing cooperative working relationships with colleagues; they encounter more sexual harassment by patients. In contrast, male nurses respond to aggressive patients and tend to resist physically caring for female patients; they encounter more physical and verbal assault from patients. These gender differences might result in differences in job-related stress. We quantitatively examined gender differences in psychiatric nurses' job stress. The Psychiatric Nurse Job Stressor Scale and the Stress Reaction Scale of the Brief Job Stress Questionnaire were administered to 159 female and 85 male Japanese psychiatric nurses. The results indicated that female nurses had significantly higher stress levels than males related to psychiatric nursing ability, attitude towards nursing, and stress reactions of fatigue and anxiety. Moreover, the factors affecting stress reactions differed somewhat between sexes. In particular, male nurses reported that greater irritability was affected by patients' attitudes. Their anxiety and somatic symptoms were affected by their attitude towards nursing, and depressed mood was affected by psychiatric nursing ability. Knowledge of these differences can lead to better mental health-care interventions for psychiatric nurses.

Investigating the impact of psychosocial risks and occupational stress on psychiatric hospital nurses' mental well‐being in Japan

A cross-sectional survey was conducted, with the aim to examine what stressors in the workplace and demographic factors were associated with signs and symptoms of poor well-being among psychiatric nurses. A structured questionnaire was distributed to nurses within six psychiatric hospitals in Japan. Information was collected on demographic information, work characteristics and two dimensions of well-being: feeling uptight and emotional exhaustion. Three hundred and sixty-one questionnaires were completed by participants. High rates of emotional exhaustion in psychiatric nurses were found to be predicted by young age, high psychological demands paired with low social support in the workplace, job strain (a proxy to occupational stress) and job strain paired with low social support. In addition, high rates of being tense/uptight were associated with high psychological job demand, low psychological job control, low social support in the workplace, high job strain and high job strain paired with low social support. The current study has found evidence of significant relationships between demographic factors and several work and organizational stressors and poor mental health among Japanese psychiatric nurses.

Moral distress experienced by psychiatric nurses in Japan

This study aimed to: (1) develop and evaluate the Moral Distress Scale for Psychiatric nurses (MDS-P); (2) use the MDS-P to examine the moral distress experienced by Japanese psychiatric nurses; and (3) explore the correlation between moral distress and burnout. A questionnaire on the intensity and frequency of moral distress items (the MDS-P: 15 items grouped into three factors), a burnout scale (Maslach Burnout Inventory - General Survey) and demographic questions were administered to 391 Japanese psychiatric nurses in 2007-2008. These nurses experienced relatively low levels of moral distress despite the fact that they were commonly confronted by morally distressing situations. All the circumstances in which the participants experienced moral distress were included in the 'low staffing' factor, which reflects the characteristics of Japanese psychiatric care. The frequency score of the low staffing factor was a significant predictor of burnout.

Countertransference to psychiatric patients in a clinical setting: Development of the Feeling Checklist–Japanese version

Countertransference is an important dimension of the therapeutic alliance between care providers and patients. The Feeling Checklist (FC) is a self-report questionnaire for the assessment of countertransference by hospital staff toward patients. The FC was translated from English into Japanese and its factor structure, reliability, and validity in the Japanese version (FC-J) were examined. A total of 281 Japanese psychiatric nurses were tested with the FC-J. All nurses were primarily involved in provision of psychiatric care. Principal-component factor analysis with varimax rotation was performed to identify the potential components of the FC-J. In a factor analysis of the FC-J, seven factors were extracted. The five subscales that were determined and labeled included Reject, Distance, Helpfulness, Closeness, and Involvement, which collectively accounted for 56.0% of the variance. Cronbach's alpha, a measure of internal consistency, for individual subscales was 0.833 for Reject, 0.763 for Distance, 0.768 for Helpfulness, 0.617 for Closeness, and 0.663 for Involvement. Notably, there was a significant correlation between the FC-J and the Nurse Attitude Scale (P < 0.0001). Moreover, one-way anova was performed with each FC-J subscale to examine differences among psychiatric diagnoses in the study sample. A significant difference was found for Involvement (P < 0.001), with the total score on Involvement being the highest in the personality disorder group. These results are considered to verify the reliability and validity of the FC-J as a scale to measure countertransference among Japanese care providers. The use of this scale allows individual care providers to recognize and be cognizant of their own countertransference objectively and thereby contributes to improve the relationship between patients and care providers.