Factors influencing the recovery-oriented attitudes of nursing directors in psychiatric hospitals: A cross-sectional study in Japan.

WHAT IS KNOWN ON THE SUBJECT?: Recovery-oriented services have been shown to promote recovery in people with mental illness; their implementation is important for current psychiatric practice and is being considered by many professional institutions. The Japanese government released the policy 'A Vision for Reform of Mental Health and Medical Welfare' (Ministry of Health, Labour and Welfare, 2004; https://www.mhlw.go.jp/topics/2004/09/dl/tp0902-1a.pdf), aiming to update public consciousness, reorganize the mental healthcare welfare system and strengthen the foundation of mental healthcare to promote a basic policy focusing on the transition 'from hospital to community life'. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This is the first study to clarify recovery-oriented attitudes among psychiatric nursing directors and related factors in Japan. It shows an association between recovery-oriented attitudes and hospital size. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: A relationship exists between the recovery knowledge and recovery-oriented attitudes of psychiatric nursing directors. It may thus be valuable for directors to see and hear about the experiences of patients living in the community during their recovery process. As hospital size and organizational climate may hinder the successful implementation of recovery-oriented practices, these factors must be considered when introducing such practices. Further research is needed on the relationship between psychiatric nursing directors' recovery-oriented attitudes and practices. Moreover, to develop intervention studies that uncover success factors for enhancing recovery-oriented attitudes, organizational factors that enable recovery-oriented practices must be further investigated. ABSTRACT: INTRODUCTION: Recovery-oriented practices in mental health services have become a global priority. Despite their proven effectiveness, Japanese hospitals have not widely implemented such practices. AIM: This study clarified psychiatric nursing directors' recovery-oriented attitudes and factors regarding promoting recovery-oriented practices to identify methods for developing these practices in Japan. METHOD: This cross-sectional study used a questionnaire survey with 250 nursing directors from 1287 Japanese psychiatric hospitals. Multivariable regression analysis assessed how socio-demographic variables and Recovery Knowledge Inventory (RKI) scores affected Recovery Attitudes Questionnaire (RAQ-7) scores. RESULTS: The analysis revealed that more clinical and managerial experience was associated with more negative recovery-oriented attitudes. High RKI scores, knowledge of strength, hospital size and outpatient work experience were associated with more positive recovery-oriented attitudes. DISCUSSION: Implementing recovery practices requires consideration of knowledge and experience in recovery and hospital size alongside recovery training based on a hospital's organizational structure. Although the low response rate could influence the study's generalisability, it could also indicate low interest in recovery-oriented practices among professionals. IMPLICATIONS FOR PRACTICE: Acquiring more knowledge and experience regarding recovery promotes recovery-oriented attitudes among nursing directors. An appropriate organizational culture and consideration of hospital size are required when introducing such recovery practices.

A Randomized Controlled Trial on Primigravid Women of Text Messaging Intervention Offering Pregnancy and Childbirth Support.

This study aimed to assess the efficacy of a text messaging intervention that offered pregnancy and childbirth support. Participants included 39 primigravid women who were less than 12 weeks pregnant. Text messages were sent twice weekly to the intervention group from week 13 of pregnancy until childbirth. Outcome measures were anxiety levels, lifestyle in the month before birth, pre-birth weight, pregnancy complications, delivery complications, birth weight, thoughts regarding the text messages, and the frequency of viewing of the text messages. For the item "I engage in body stretching," the average value in the intervention group was significantly higher than that in the control group. For the item "I have regular bowel movements," the average value in the intervention group was significantly lower. Most participants reported that the intervention was at least somewhat useful. This study indicates that text messaging intervention is practical and can be used to support numerous pregnant women simultaneously at a relatively low cost. Since this is a study pilot trial, large-scale studies are necessary to improve the method and allow for the generalization of the results.

Penetration of Singlet Oxygen into Films with Oxygen Permeability Coefficient Close to that of Skin.

Although its antiviral and antibacterial functions help prevent infection, singlet oxygen (1 O2 )-which is generated by the action of light on an endogenous photosensitizer-is cytotoxic. In the present study, we investigated the ability of 1 O2 -generated by the action of visible light on a photosensitizer-to penetrate skin. We used two polymer films with oxygen permeability coefficients similar to that of skin-i.e. cellulose acetate (CA) and ethyl cellulose (EC). Both films contained 1,3-diphenylisobenzofuran (DPBF), which was used as an 1 O2 probe. 1 O2 generated externally did not permeate the films by mere contact. Therefore, we conclude that the potential for 1 O2 to penetrate the skin is very low, and films that generate 1 O2 are safe and useful for preventing infections by contact. We also proved that 1 O2 can move between the layers of integrated polymer films when they are joined together.

A Pilot Randomized Controlled Trial of a Text Message Intervention to Promote Help Seeking for Psychiatric Outpatients.

Mental illness often affects and is affected by other diseases, such as cardiovascular disease, cancer, and AIDS/HIV infection, and people living with mental illness require additional common services and resource mobilization efforts. Therefore, we developed a mobile phone intervention and conducted a randomized controlled trial with 45 psychiatric outpatients with mental illnesses. Data from 39 individuals (intervention group: 20, control group: 19; mean [SD] age, 44.64 [14.12] years) were included in the analyses. The intervention involved the promotion of help-seeking behaviors by sending text messages, including information about social welfare services, for 3 months. After the intervention period, no significant differences were found in the proportion of help-seeking behaviors between the intervention and control groups. However, concerning the reason for not using social services, the proportion of participants who answered "I do not know how to use it" in the intervention group was significantly lower compared to the control group. More than 80% of participants in the intervention group reported that the text messaging service was helpful and useful, and they wanted more messages and information. This was the first randomized controlled trial to promote psychiatric patients' help-seeking behavior using text messaging. Moreover, the text messaging intervention was found to be cost-effective.

Gender differences of the influential factors on the mental health condition of teachers in the A university.

The purpose of this research was to investigate the gender differences of the influential factors on the mental health condition among university teachers in the A university in Japan. A questionnaire survey was mailed to 924 university teachers in Japan, with a survey return rate of 43.8% (N=405). The General Health Questionnaire 28 (GHQ-28), Multidimensional Scale of Perceived Social Support (MSPSS), the Japanese version of the Brief Coping Orientation to Problems Experienced (COPE) and the Work Situation Questionnaire (WSQ) developed by the authors were administered to subjects. The GHQ-28 total score and all of sub-score of the woman was significantly higher than men. In the correlated factor of mental health, level of job satisfaction and job control, social support of significant others was observed in the both sexes. However, gender differences was observed in the coping style. Some copings including self-distraction and self-blame were related to the men, but the woman was related to the substance use. University teachers had some gender differences in the factors affecting their mental health condition. In order to improve university teacher's mental health condition, it is necessary to increase their level of job satisfaction and feeling of job control in the workplace. Especially, it was considered women's coping using substance use was important.

Factors associated with discharge of long-term inpatients with schizophrenia in Japan: a retrospective study.

Deinstitutionalization for people with mental disorders has only begun to be implemented in Japan. The purpose of this retrospective study was to examine factors associated with discharge for long-term patients with schizophrenia. Seventy patients were judged capable of discharge with psychiatric rehabilitation (special staff service). As a result of rehabilitation efforts, 37 patients were discharged and 33 patients remained in the hospital. Significant differences were found in age, level of family agreement about patient's disability, and length of the special staff service. These factors might be important to predict patients' potential for discharge.

Retrospective study of Japanese patients with schizophrenia treated with aripiprazole.

Aim. The purpose of this retrospective study was to evaluate changes in clinical indicators which influence the quality of life (QOL) of patients with schizophrenia treated by antipsychotic therapy before and after switching to aripiprazole. Methods. A retrospective chart review of 27 patients diagnosed with schizophrenia and who were switched from one antipsychotic to aripiprazole was performed. Clinical indicators about the daily dosage of antipsychotics and antiparkinsonian drugs, psychiatric condition, and glucose/lipid metabolism, clinical evaluation by nursing observation were used to measure the responsiveness of subjects to aripiprazole. Results. Of the 27 subjects, 14 responded to the switch to aripiprazole with significant improvement of the Brief Psychiatric Rating Scale (BPRS) score (P = 0.04), significant decrease in dosage of antipsychotics in 71% of patients (P = 0.03), and tendency toward reduction in dosage of antiparkinsonian drugs (P = 0.07) and body mass index (BMI) (P = 0.06). However, 8 of 27 subjects had a significant increase in lipid levels after switching to aripiprazole (P = 0.01). Conclusion. QOL for subjects who responded to the switch to aripiprazole improved as indicated by lower doses of antipsychotic and antiparkinson medications, improvement in BPRS score, and a decrease in BMI. Results indicate little influence on patient's QOL.

The role of nurse administrators and managers in quality psychiatric care.

Psychiatric healthcare services in Japan demand continuous improvement to ensure quality care. Psychiatric nurse administrators and managers greatly influence the quality of services. To improve treatment, the following are considered necessary: clarification of service goal, proper assessment of treatment outcome, shortening of hospitalization, patient-centered care, establishment of trust relationships based on open communication with patients, and effective interdisciplinary teamwork. Additionally, administrators and managers must evaluate the clinical competence of individual nurses and appropriately assign them, especially when personnel shortage is an issue. Furthermore, in collaboration with other healthcare professionals, nurse managers must provide optimal care by setting goals of psychiatric services for patients in acute, sub-acute, or convalescent phases. This article presents the roles of nurse administrators and managers in improving the quality of Japanese psychiatric healthcare services.

[The active contribution of the laboratory to the diagnosis and recovery of patients --resolution of sampling-related problems is important].

The objective of this symposium was to promote effective communication between medical doctors (MD) and medical technologists (MT) for efficient team-based medical treatment. We analyzed a model patient with disseminated intravascular coagulation (DIC) to demonstrate our strategy, primarily as clinical laboratory hematologists. To assess the response of the clinical central laboratory to severe septic DIC, questionnaires on the performance of laboratory tests for DIC at night were sent to the laboratories of six hospitals in the Nara area. Extra tests other than those fixed for the emergency room were carried out in many laboratories in response to requests from the doctors. This tendency was more marked in smaller sized laboratories; therefore, the level of communication was better in these smaller laboratories. Forty MTs filled out the questionnaires on the blood coagulation test and influence of sampling and others, especially pertaining to the night shift, and their responses were relatively favorable, but more active approaches and information were needed even if their subspecialty was not clinical hematology. In our cases of thrombotic thrombocytopenic purpura and May-Hegglin anomaly, active and specific laboratory-based participation contributes to the diagnosis and treatment. In conclusion, the most important point is that MTs and MDs show respect for each other and communicate cordially, because our final mutual goal is the recovery of the patient.