Recovery-oriented daily care practice for community-based mental health service consumers in Japan: A grounded theory approach.

Recovery, which is a non-linear, unique process allowing mental health service consumers to live autonomously, has become a prominent concept. However, adapting recovery-oriented practice to daily care is challenging. We explored recovery-oriented practice among mental health professionals in Japan via semi-structured interviews including nurses, occupational therapists, and psychiatric social workers (17 professionals in total). Data were analysed using grounded theory. Six categories emerged. The core category was 'Continuing to adjust care to meet consumers' needs for their unique lives'. The professionals stated that they practised in accordance with the service consumers' sincere hopes based on an equitable relationship because they believed that this approach would enhance consumers' personal agency, proactive behaviour, and self-choice. Despite negative consequences, the professionals did not view the consumers' choices as 'failures' and instead helped them to find meaning in their experiences. Although the therapeutic relationship tended to be paternalistic, participants described how concrete practices helped build an equitable relationship. In recovery-oriented practice, the provision of support centred on consumer values is important, without imposing own's own values. Care practices should also be aligned with consumers' hopes, needs and goals.

Impact of individual factors and personality trait on psychological problems of family members living with staff of a COVID-19 frontline hospital: A cross-sectional self-administered anonymous questionnaire survey.

Aim: This study aims to evaluate the association between individual factors/personality traits and depression and anxiety in family members living with staff working on the frontline of COVID-19 care. Methods: The subjects were family members over the age of 15 years living with staff members of a COVID-19 frontline hospital. Between March 27 and April 11, 2021, 204 self-administered anonymous questionnaires were distributed, and 149 responses were received. Symptoms of depression and anxiety were assessed using the Hospital Anxiety and Depression Scale (HADS). Personality trait was assessed using the Big Five personality traits, and fear of COVID-19 was assessed using the Fear of COVID-19 Scale. We examined associations between HADS depression or anxiety scores with individual background factors, scores of Big Five personality traits, and Fear of COVID-19 Scale. Results: The participants with anxiety had significantly higher scores for neuroticism and for the Fear of COVID-19 Scale. The participants with depression had significantly lower scores for extraversion and higher scores for the Fear of COVID-19 Scale. No individual background factors were significantly associated with HADS depression or anxiety scores. Conclusion: Among family members of staff of a COVID-19 frontline hospital, lower extraversion, higher neuroticism, and fear of COVID-19 were associated with anxiety and depression. This questionnaire survey was conducted before wide-spread rollout of COVID-19 vaccination, so the findings of this study are expected to be applicable to other future novel infectious outbreaks.

The Big Five personality traits and the fear of COVID-19 in predicting depression and anxiety among Japanese nurses caring for COVID-19 patients: A cross-sectional study in Wakayama prefecture.

Recent studies have found a relationship between fear of COVID-19 and mental health problems. Medical workers caring for COVID-19 patients tend to suffer from mental health problems; however, the impact of their personality traits, in the form of mental problems like depression and anxiety in Japan is unclear. In this study, we investigated the risk of nurses' depression and anxiety, predicted by the fear of COVID-19 and the Big Five personality traits. A total of 417 nurses working in hospitals providing care to COVID-19 patients in Wakayama prefecture of the Kansai region participated in this study. The questionnaires comprised items on nurses' basic characteristics and three scales: the Fear of COVID-19 Scale 2020, the Big-Five Scale, and the Japanese version of the Hospital Anxiety and Depression Scale (HADS). Depression and anxiety in the HADS were set as dependent variables, and basic attributes, fear, and personality traits as independent variables; multivariate logistic regression analyses were conducted. The questionnaire, with no missing items was distributed from February to March 2021. Neuroticism (OR = 1.06, 95%CI = 1.03-1.09) was the only significant factor associated with the depression symptom, and both FCV-19S scores (OR = 1.16, 95%CI = 1.09-1.23) and neuroticism (OR = 1.09, 95%CI = 1.06-1.13) were the significant factors associated with anxiety. The Nagelkerke's R squared was 0.171 in the depression model and 0.366 in the anxiety model. Thus, it was found that it is necessary to support nurses' mental health by developing methods suitable to their personalities.

The Effect of Nurses' Characteristics and Motivation on the Development of Their Career Intentions.

The aim of this study is to enrich nursing education by clarifying the relationship between personality traits, motivation, and career paths in professional nursing. This cross-sectional study surveyed 150 nurses from a polyclinic in Japan that performs internal medicine and surgery. The survey covered several aspects of personality, work motivation, and career development using the Ten-Item Personality Inventory, Work Motivation Scale, and Nurses' Job Career Scale. The demographics of the participants were also recorded. Multiple regression analysis revealed that the personality traits extraversion and agreeableness had a direct and positive impact on nurses' interest in team collaboration, but not on career development. Interest in career improvement was related to conscientiousness as a power toward purpose and openness as an aspect of curiosity. Conscientiousness and openness were indirectly related to the development and adjustment of interpersonal relationships and self-capability development through interest in career improvement. Interest in patient support positively impacted the implementation and pursuit of quality nursing. The findings highlight the need to account for individual differences in personality and motivation to support nurses' success during their nursing education and in the workplace.

Validity and reliability of Psychiatric Nurse Self-Efficacy Scales: cross-sectional study.

OBJECTIVES: To develop the Psychiatric Nurse Self-Efficacy Scales, and to examine their reliability and validity. DESIGN: We developed the Improved Self-Efficacy Scale (ISES) and Decreased Self-Efficacy Scale (DSES) using existing evidence. Statistical analysis was conducted on the data to test reliability and validity. SETTING: The study's setting was psychiatric facilities in three prefectures in Japan. PARTICIPANTS: Data from 514 valid responses were extracted of the 786 responses by psychiatric nurses. OUTCOME MEASURES: The study measured the reliability and validity of the scales. RESULTS: The ISES has two factors ('Positive changes in the patient' and 'Prospect of continuing in psychiatric nursing') and the DSES has three ('Devaluation of own role as a psychiatric nurse', 'Decrease in nursing ability due to overload' and 'Difficulty in seeing any results in psychiatric nursing'). With regard to scale reliability, the Cronbach's alpha coefficient was 0.634-0.845. With regard to scale validity, as the factorial validity of the ISES and DSES, for the ISES, χ2/df (110.625/37) ratio=2.990 (p<0.001), goodness-of-fit index (GFI)=0.962, adjusted GFI (AGFI)=0.932, comparative fit index (CFI)=0.967 and root mean square error of approximation (RMSEA)=0.062; for the DSES, χ2/df (101.982/37) ratio=2.756 (p<0.001), GFI=0.966, AGFI=0.940, CFI=0.943, RMSEA=0.059 and Akaike Information Criterion=159.982. The concurrent validity of the General Self-Efficacy Scale was r=0.149-0.446 (p<0.01) for ISES and r=-0.154 to -0.462 (p<0.01) for DSES, and the concurrent validity of the Stress Reaction Scale was r=-0.128 to 0.168 for ISES, r=0.214-0.398 for DSES (p<0.01).Statistical analyses showed the scales to be reliable and valid measures. CONCLUSIONS: The ISES and DSES can accurately assess psychiatric nurses' self-efficacy. Using these scales, it is possible to formulate programmes for improving psychiatric nurses' feelings of self-efficacy.

Attitudes related to social distance between commissioned welfare volunteers (minsei-iin) and people with mental illness.

Objective: This study explored the factors influencing commissioned welfare volunteers' (CWVs) attitudes toward mental illnesses and how their attitudes correlated with their social distance from people with mental illness. Materials and Methods: Data from 223 CWVs were analyzed statistically. Factor extractions for the Image for Mental Illness Scale (IMI) and Social Distance Scale (SDS) were calculated. We examined the relations between factors in IMI and SDS. Results: CWVs' attitudes were classified as Understanding (understanding of the condition), Secure (feelings of safety in the presence of those with mental illness), and Activity (reactions to the behaviors of people with mental illness). Social distance from those with mental illness was classified as Public and Private Interactions. CWVs' interactions with people with mental illness were significantly influenced by feeling Secure in the presence of the latter. Low Public and Private Interactions were influenced by older age. CWVs' "experience in providing consultations for mental illness" led to the avoidance of Private Interactions. Conclusion: CWVs should feel safe when involved in Public or Private Interactions with individuals with mental illness. CWVs reported a preference for a higher level of social distance from people with mental illness.

Exploration of the factors related to self-efficacy among psychiatric nurses.

The average length of hospital stay in the psychiatric ward is longer, and the risk of patient-to-nurse violence is higher than that in other departments. Therefore, psychiatric nurses' work environment may differ from that of other nurses. The factors related to psychiatric nurses' self-efficacy may also differ from those of general workers or other nurses. Mental health care that considers the characteristics of psychiatric nurses requires exploration of self-efficacy unique to psychiatric nurses. This cross-sectional study aimed to explore the distinct factors related to psychiatric nurses' self-efficacy. The developed 24 items related to improvement in self-efficacy and 25 items related to decrease in self-efficacy were examined. The Generalized Self-Efficacy Scale was used to measure the validity of the factors. To extract the factors of self-efficacy, data from 132 nurses and assistant nurses who provided informed consent were analyzed, and the reliability and validity of the factors were calculated. The factors associated with improvement in self-efficacy were "Positive reactions by patients," "Ability to positively change nurse-patient relationship," and "Practicability of appropriate nursing." The factors associated with decrease in self-efficacy were "Uncertainty in psychiatric nursing" and "Nurses' role loss." The Cronbach's α for all factors exceeded .70. Of the five factors, four had significant weak-to-moderate correlations with the Japanese version of the Generalized Self-Efficacy Scale; therefore, the validity was quantitatively confirmed with four factors. Interventions based on these four factors may improve psychiatric nurses' self-efficacy. Additionally, it is possible that this tool assesses the unique facets of self-efficacy rather than psychiatric nurses' general self-efficacy. Interventions to improve psychiatric nurses' self-efficacy based on the characteristics of psychiatry are needed.

Experiences of caregivers desiring to refuse life-prolonging treatment for their elderly parents at the end of life.

Purpose: This study aimed to clarify the experiences of caregivers desiring to refuse life-prolonging treatment for their elderly parents at the end of life. Methods: A semi-structured interview was performed for four family caregivers who wanted to refuse life-prolonging treatment suggested by the physicians. Results: In this study, four caregivers who refused life-prolonging treatment suggested by the physicians for their elderly parents completed semi-structured interviews. The obtained data were analyzed in relation to the theme "Experiences of caregivers who desire to refuse life-prolonging treatment for their elderly parents at the end of life." As a result, 38 subcategories and 12 categories were extracted. Conclusions: Participants in this study initially had a negative view of life-prolonging treatment. However, they agonized over the decision when they received conflicting advice from the physicians. The participants indicated that physicians' advice and attitudes complicated their decisions to reject life-prolonging treatment for their elderly parents.

Nurses' Experiences of End-of-life Care in Long-term Care Hospitals in Japan: Balancing Improving the Quality of Life and Sustaining the Lives of Patients Dying at Hospitals.

PURPOSE: In Japan, about 80% of deaths occur in hospitals, especially long-term care beds. The purpose of this study was to clarify the nursing practices used for such older patients at the end-of-life stage in long-termcare wards via the modified grounded theory approach (M-GTA). METHODS: Data were obtained through semi-structured interviews of nineteen nurses working in cooperating long-term care wards, acute care wards, or hospice services (to allow for constant comparison between these types of wards) in western Japan in 2014. We analyzed the transcribed data using M-GTA. RESULTS: The core category that emerged from the analysis was "Balancing enhancement of patients' daily life quality and life-sustaining care in the face of uncertainty about the patients' character." Eleven categories emerged, such as Seeking older patients' character with their family, Supporting families' decision making, Rebuilding patients' daily life in the ward, and Sustaining patients' life span through medical care. CONCLUSIONS: Nurses experienced uncertainty about the care needs of older patients, the ethical problems of Enhancing the patients' QOL by using risky care, and the evaluation criteria used to judge their own nursing care after the patients' death. All nurses had the goal of ensuring a natural death for all patients. Nurses' acceptance and evaluation of their own care was critically influenced by the patient's family's responses to their care after patients' death. Further research is necessary to develop evaluation criteria and educational programs for end-of-life nursing care of older adults.

Factors Relating to Self-Efficacy Among Psychiatric Nurses.

This study aimed to clarify the factors related to self-efficacy experienced by psychiatric nurses. Analysis of qualitative descriptive data from a free self-description questionnaire administered to 16 psychiatric nurses working in psychiatric hospitals revealed 24 codes across the following 8 categories as factors that increase self-efficacy: A1. possibility of practical use in nursing, A2. nursing judgment, A3. improvement of psychiatric symptoms, A4. the patients presenting a positive attitude, A5. building a relationship of trust with the patients, A6. building a relationship of trust with other nurses, A7. work progressing according to plan and A8. team medical practice. Twenty-five codes across the following 10 categories were identified as factors that decrease self-efficacy: B1. lack of communication, B2. uncertainty in caregiving, B3. recurrence of psychiatric symptoms, B4. feeling overpowered by a patient, B5. sense of being too busy to work adequately, B6. difficulty in bringing about self-improvement, B7. sense of loss regarding one's role as a nurse, B8. lack of physical strength, B9. mechanical performance of nursing and B10. fluctuating view of nursing due to mistakes. These factors require intervention for psychiatric nurses' self-efficacy.

The Relation Between the Nurses' Difficulties About Care for People with Mental Disorder in General Wards and Their Negative Feeling About Hospitalization of the People.

The aim of this study was to explore the relations between nurses' difficulties in caring for persons living with mental disorders and negative feeling about hospitalization of these persons in general wards. Out of 150 nurses working in a local general hospital in Japan, 86 were eligible for this study. Exploratory factor analysis of the question items for symptoms and conditions with which the nurses had difficulty revealed two principal factors: symptoms like psychosis and neurosis. These factors were then compared in terms of the attitudes that nurses had toward hospitalizing those persons with mental disorders. The greater the negative attitudes toward hospitalizing the persons with mental disorders, the greater the difficulty in caring for them. It is thought that symptoms like psychosis were considered to be caused by schizophrenia, epilepsy, and dementia, and symptoms like neurosis were caused by mood disorder, personality disorder and depression. These principal factors seemed to be with two different difficulties. One is about dealing with their symptoms, another is to distinguish them. Non-psychiatric nurses seemed to be working without confidence in caring for those with mental health disorders. We thought the workloads were increased by symptoms like psychosis and mental burdens on nurses as emotional labors were increased by symptoms like neurosis. Therefore, it is necessary for nurses working in general wards to improve the consultation support system about mental disorders.

[Current State of Studies on Job-related Stress among Psychiatric Social Workers and Insights into Future Research].

We studied the characteristics of psychiatric social workers (PSWs) and present research on job-related stress among them; we also provide insights into the future of such research. In recent years, studies on job-related stress among PSWs have been gaining interest. In particular, stress associated with the repeated revisions of related laws has increased. Subsequently, it was found that occupational stress in PSWs differs qualitatively and quantitatively depending on educational history, years of experience, and service department. However, no scale captures the specific characteristics of job-related stress among PSWs. Moreover, the development of a mental health care program for PSWs seems difficult. To develop a mental health care program that caters specifically to this group, future research should focus on developing a scale that determines the specific characteristics of job-related stress among PSWs, which should be evaluated on the basis of each PSW's educational history, years of experience, and service department.