Patient advocacy: Japanese psychiatric nurses recognizing necessity for intervention.

BACKGROUND: 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. OBJECTIVES: This article explores Japanese psychiatric nurses' decision to intervene as a patient advocate and examine their ethical, cultural, and social implications. RESEARCH DESIGN: 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. PARTICIPANTS AND RESEARCH CONTEXT: The participants were 21 nurses with 5 or more years of experience in psychiatric nursing. ETHICAL CONSIDERATIONS: The research was approved by Institutional Review Board of research site and study facilities. The participants gave written informed consent. FINDINGS: 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. DISCUSSION: 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. CONCLUSION: 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.

Factors affecting turnover of Japanese novice nurses in university hospitals in early and later periods of employment.

AIM: To explore the factors affecting turnover of novice nurses during the 10th-15th months of employment in comparison with those during the preceding 6 months. BACKGROUND: The early turnover of novice nurses is a serious issue. Our previous study showed that 4.0% (37/923) of novice nurses quit their jobs in the initial 3rd-9th months of employment. The major determinants of their turnover were education (i.e. graduation from vocational nursing schools), undesired ward assignment and lack of peer support. METHODS: The cohort of 762 novice nurses from our previous study was followed up during the next 10th-15th months of employment. Their turnover in this period was predicted using variables from baseline data such as demographic attributes, burnout (J-MBI), assertiveness (J-RAS) and perceptions about the workplace. RESULTS: The findings showed that 4.6% (35/762) of novice nurses quitted their jobs during the first 15-month period. The factors affecting the turnover were: burnout, dissatisfaction with the workplace and hospital location being in Tokyo. All these factors were different from those observed for the preceding follow-up period. CONCLUSION: Burnout was revealed to be the most significant factor affecting the turnover of novice nurses. Implications for nursing management Nurse managers should be vigilant and exercise care in the prevention of burnout among novice nurses.

Significant increase of oral bacteria in the early pregnancy period in Japanese women.

AIM: Oral microflora during pregnancy is critical to oral health care in the mother and her child. We examined the changes in the oral microbiota between pregnancy and nonpregnancy periods. METHODS: The study was performed using 132 healthy pregnant women enrolled from Hiroshima City Asa Citizens Hospital and 51 healthy nonpregnant women as control. During pregnancy, 132 subjects were assessed for seven microbial species by the cultured method and polymerase chain reaction at the early (7-16 weeks gestation), the middle (17-28 weeks), and the late (29-39 weeks) pregnancy periods. Pregnant women completed a series of questionnaires regarding oral and systemic health and lifestyle habits. RESULTS: The total cultivable microbial counts in the early pregnancy were significantly higher than that of the nonpregnant women (P < 0.05). The incidences of Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans in gingival sulcus during the early and middle pregnancy were significantly higher than the nonpregnant group (P < 0.05), while Prevotella intermedia and Fusobacterium nucleatum did not change. Candida species were more frequently detected during the middle and late pregnancy. CONCLUSION: The data suggest that pregnancy, especially in the early periods, promotes the proliferation of microorganisms in the oral cavity and facilitates a colonization of periodontal pathogens.

Factors involved in the feelings related to school avoidance among high school students in Nagano Prefecture, Japan.

AIM: The present study aimed to identify the factors that are involved in the feelings related to school avoidance of high school students in order to develop a support method and a strategy for preventing school maladjustment. METHOD: A total of 1756 students from three public high schools in Nagano Prefecture in Japan agreed to participate in the study. They were asked to complete the Feelings of School Avoidance (FSA) Scale, as well as information relating to their demographic details, living environment, lifestyle, and psychosocial factors. RESULTS: Valid responses were obtained from 1178 students. The mean scores of all three subscales of the FSA Scale increased with the students' grade. In the hierarchical multiple linear regression analysis, the students' age, family size, and social support were excluded from the predictors and the anthropophobic tendency and social skills were analyzed separately in order to avoid multicollinearity. When the anthropophobic tendency was included, the students' grade, anthropophobic tendency, self-esteem, and support by school friends were significant predictors for all the FSA subscales. When the level of social skills was included instead of the anthropophobic tendency, the analysis yielded similar results, except that the students' social skills and unidentified complaints were selected instead of the anthropophobic tendency. CONCLUSION: Among the high school students, the anthropophobic tendency contributed to their feelings related to school avoidance most strongly. These results suggest the necessity of understanding students' anthropophobic tendency in detail, developing effective support in order to promote their social skills and self-esteem, and helping them to make friends, as well as improving their human relationships in order to prevent school maladjustment.

Relationship between assertiveness and burnout among nurse managers.

AIM: We aimed to clarify the relationship between assertiveness and burnout among nurse managers at university hospitals. METHODS: The directors at three university hospitals agreed to cooperate with our study. During a one-month period from May to June 2007, a self-administered questionnaire was distributed to 203 nurse managers (head and sub-head nurses). The Japanese version of the Rathus Assertiveness Schedule (J-RAS) and the Japanese version of the Maslach Burnout Inventory (MBI) were used as scales. Burnout was operationally defined as a total MBI score in the highest tertile. RESULTS: Valid responses were obtained from 172 nurse managers. The mean J-RAS score of the burnout group (-14.3) was significantly lower than that of the non-burnout group (-3.3). Responses about work experience and age showed no significant group difference. Total MBI score was inversely correlated with J-RAS score (R = -0.30, P < 0.01). Multiple logistic regression analyses indicated a decrease in the risk of burnout by 26% (0.74 times) for every 10 point increase in the J-RAS score, and by 60% (0.40 times) for greater satisfaction with own care provision. CONCLUSIONS: The results suggest that increasing assertiveness and satisfaction with own care provision contributes to preventing burnout among Japanese nurse managers.