Mothers' experiences of parenting a child with chromosomal structural abnormalities: The journey to acceptance.

PURPOSE: This study aimed to investigate the process mothers go through in coming to terms with raising a child with chromosomal structural abnormalities. METHODS: Sixteen mothers living in Japan were interviewed and a modified grounded theory approach was used for the analysis. RESULTS: A total of 35 concepts, nine subcategories, and six categories were extracted. The six categories were: (a) Concern about abnormalities; (b) A healthy child is considered as a standard; (c) Deepening attachment to the child; (d) Acceptance of the child as s/he is; (e) Changing attitude toward disabilities; (f) Creating a frontier for other mothers. The parenting journey meant that parents did not move in a straightforward way from the beginning of the process to the endpoint but instead moved between "Deepening attachment to the child" and "Acceptance of the child as s/he is" before they moved ahead. CONCLUSION: Having support and meeting peers of mothers with similar issues is essential for mothers to review their perspectives that healthy children are the standard against which to measure their child and to motivate them to raise their children, but it was extremely difficult to have such opportunities due to rarity of the disorder. It is crucial to accumulate more practical information so that mothers can access and use it. Mothers also need support to enhance their self-worth while giving due consideration to the possibility that they may be conscious of being stigmatized. Nurses need to advocate for these children and families to get the appropriate help, understanding and support.

The role of online ethics consultation on mental health.

BACKGROUND: Nurses experience moral distress when they cannot do what they believe is right or when they must do what they believe is wrong. Given the limited mechanisms for managing ethical issues for nurses in Japan, an Online Ethics Consultation on mental health (OEC) was established open to anyone seeking anonymous consultation on mental health practice. RESEARCH OBJECTIVE: To report the establishment of the Online Ethics Consultation and describe and evaluate its effectiveness. ETHICAL CONSIDERATIONS: The research was conducted in accordance with the Declaration of Helsinki. RESEARCH DESIGN: This evaluation describes the outcomes of 5 years of operation of the Online Ethics Consultation on mental health in Japan. PARTICIPANTS: The Online Ethics Consultation received 12 emails requesting consultation. Consultees included mental health nurses, psychiatrists, and service users. FINDINGS: The most common questions directed to the service were about seclusion and physical restraint. Response time from receipt of email to sending a reply was between 1 and 14 days. Despite the disappointing number of consultations, feedback has been positive. DISCUSSION: The Online Ethics Consultation was established to assist morally sensitive nurses in resolving their ethical problems through provision of unbiased and encouraging advice. Mental health care in Japan has been less than ideal: long-term social hospitalization, seclusion, and restraint are common practices that often lead to moral distress in nurses and the questions received reflected this. The head of the Online Ethics Consultation sent a supportive, facilitative response summarizing the opinions of several consultants. CONCLUSION: This study provides key information for the establishment of an online ethics resource the adoption of which has the potential to improve the experience of nurses, allied health and clients of mental health services. This paper has implications for services concerned with improving patient care, managing nurses' moral distress, building ethics into decision-making.

Developing competencies in genetics nursing: Education intervention for perinatal and pediatric nurses.

Nurses need to be appropriately trained in genetics to provide clinical care based on best practice for patients and families. This exploratory study describes an educational intervention using authentic stimulus material centered on a clinical case study of a family with a baby with Down syndrome. Quantitative and qualitative data were collected from a sample of 15 nurses and 27 students from three universities in Japan before and after completing an entry-level workshop on competency-based genetics nursing. Participants reported increased perceived genetics knowledge and clinical confidence. Despite more than 90% of the participants reporting that they understood the underlying genetics knowledge, their confidence and the ethical aspects of genetics nursing had not been promoted after the seminar. In contrast, the reflections, coded into three categories, showed they recognized families' needs for psychological support, family decision making, and protection and privacy and suggested that nurses had undergone a profound shift in understanding about these issues. Although indicating that a single seminar was insufficient, the study findings will be useful to develop educational materials on genetics for both students and nurses.

Stigma towards depression in a community-based sample in China.

OBJECTIVE: Understanding the general public's beliefs about depression is essential if public education and anti-stigma interventions are to be effective. This study aimed to examine Chinese respondents' personal attitudes towards depression and their perceptions about the attitudes of others regarding depression and to identify the correlates of personal stigma and perceived stigma towards depression. METHODS: A community survey was conducted among 1697 residents aged between 16 and 89 years of a large city in central China using the Depression Stigma Scale. Participants completed questionnaires assessing experiences of depression and family functioning. RESULTS: Participants reported high levels of stigma towards depression, with greater perceived stigma than personal stigma. Increasing age was correlated with greater personal stigma and perceived stigma. Higher personal stigma was also significantly correlated with being male, unemployed and good family function. CONCLUSION: Concerningly high levels of stigmatizing beliefs towards depression were prevalent among the public. This may be a reason why people with mental disorders do not seek assistance. This highlights the importance of the need for health education and promotion activities. Findings from this study suggest that targeted, culturally appropriate education programs are needed to improve knowledge about depression in the broader community.

Sleep disturbances and related factors among nurses.

The aim of this study was to describe patterns and potential risk factors for sleep disturbances, including that of sleep apnea, among Thai registered nurses. A descriptive, cross-sectional design was implemented. A sample of 233 registered nurses was recruited from 10 nursing departments from a tertiary hospital. Participants completed a one-time, self-report questionnaire and a 1 week-long sleep diary. Descriptive and logistic regression statistics were used for the analysis. Approximately 76% of nurses slept less than 7 h, 12.3% had difficulty initiating sleep, and 5% had difficulty maintaining sleep. Short sleep duration was prevalent, and night shift work schedules that exceeded 10 episodes/month were perceived as contributing to difficulties with initiating sleep. After excluding males from the analysis, the risk for depression related to short sleep duration becomes statistically significant. Organizational policies for registered nurses' shift work should include effective management of night shift assignments, as well as interventional strategies and policy directions, to promote sleep quality and mental health to ensure nurse well-being and patient safety.

Evaluating the impact of an assertiveness communication training programme for Japanese nursing students: A quasi-experimental study.

AIM: To examine the impact of an assertiveness communication training programme on Japanese nursing students' level of assertiveness and intention to speak up when concerned about patient safety. DESIGN: A quasi-experimental design with two parallel groups was used. METHODS: Third-year nursing students from two Japanese educational institutions were allocated to an intervention and control group. The intervention group completed the Theory of Planned Behaviour-Assertive Communication Questionnaire and the Japanese version of the Rathus Assertiveness Schedule after attending assertive communication workshops. The second group completed the surveys before attending the workshop and were referred as the control group. Data were collected in December 2017-January 2018. RESULTS: A total of 123 out of 150 nursing students completed the surveys. Following the assertiveness communication training programme, a higher percentage of students from the intervention group demonstrated the intention to speak up. The intervention group also displayed higher levels of assertiveness, although the results were not statistically significant.

Design and evaluation of an assertiveness communication training programme for nursing students.

AIMS: The aims of this paper are to (a) outline the design and implementation of an evidence-based assertiveness communication workshop for Japanese nursing students; and (b) report on the evaluation of nursing students' satisfaction with the workshop using the Satisfaction with Assertiveness Communication Training Program Survey. BACKGROUND: A body of research attests to the relationship between assertive communication and patient safety. This paper reports the design and evaluation of an assertiveness communication training programme designed to enhance students' ability to communicate safety in clinical practice. DESIGN: A culturally appropriate and evidence-based assertiveness communication workshop, informed by Gagne's instructional design principles, was implemented for third-year nursing students in two Japanese higher educational institutions in December 2017. A descriptive study design was used to evaluate the workshop. METHODS: Students' perceptions of the workshop were evaluated using the Satisfaction with Assertiveness Communication Training Program Survey, which includes ten items that are rated using a 5-point Likert scale from strongly disagree [1] to strongly agree [5]. Data were analysed using descriptive statistics. The Revised Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) guidelines were used in the reporting of this study. RESULTS: A total of 111 students from a population of 150 participated in the study giving a response rate of 74%. The overall mean satisfaction score was 4.12 indicating a high level of agreement with each of the survey items. With the exception of two items, the mean scores were above 4.0. "Confidence in using assertiveness communication skills" and "Utilising role-plays to practice learnt skills" received mean scores of 3.71 and 3.90, respectively. CONCLUSION: Given the compelling research about the importance of assertive communication in health care, the results from this study support continuing investment in assertiveness communication training programmes for nursing students. RELEVANCE TO CLINICAL PRACTICE: Assertive communication is an essential communication skill for safe nursing practice. Culturally appropriate assertiveness communication training programmes are of particular relevance in hierarchical healthcare contexts.

Developing leadership and capacity building: Reflections of a nurse leader.

Globally, leadership in nursing and healthcare is vital to develop professional skills and knowledge to improve both practice and population health. Much can be learned from the leadership experiences of others, such as Professor Wipada Kunaviktikul from Thailand, a well-known nursing leader. Among her many life achievements, she is a founding member of the Editorial Board of Nursing & Health Sciences and was invited to share her life story with readers. Her life story includes experiences of leadership and capacity building in health, administration and education, across many organizations nationally and internationally. She describes how her early experiences contributed to her later achievements, such as working to establish international relationships, networks and collaborating centers, and English-language nursing degrees and training courses for Thai and international students. Nurses and other health professionals can reflect on how her values and commitment to nursing excellence have shaped her leadership style to the present time. The importance of role models and mentors in capacity building for leadership is emphasized in her personal leadership development and in the development of other leaders. In conclusion, leadership suggestions are given for future and present nursing leaders.

Exploring Japanese nurses' perceptions of the relevance and use of assertive communication in healthcare: A qualitative study informed by the Theory of Planned Behaviour.

BACKGROUND: The hierarchical nature of healthcare environments presents a key risk factor for effective interprofessional communication. Power differentials evident in traditional healthcare cultures can make it difficult for healthcare professionals to raise concerns and be assertive when they have concerns about patient safety. This issue is of particular concern in Japan where inherent cultural and social norms discourage assertive communication. AIM: The aim of this study was to (a) explore nurses' perceptions of the relevance and use of assertive communication in Japanese healthcare environments; and (b) identify the factors that facilitate or impede assertive communication by Japanese nurses. DESIGN: A belief elicitation qualitative study informed by the Theory of Planned Behaviour was conducted and reported according to the COnsolidated criteria for REporting Qualitative research. SETTINGS AND PARTICIPANTS: Twenty-three practicing Japanese registered nurses were recruited by snowball sampling from October 2016 to January 2017. METHODS: Individual face-to-face semi-structured interviews were conducted and transcribed in Japanese and then translated into English. Two researchers independently conducted a directed content analysis informed by the Theory of Planned Behaviour. Participants' responses were labelled in order of frequency for behavioural beliefs about the consequences of assertive communication, sources of social pressure, and factors that facilitate or impede assertive communication in Japanese healthcare environments. FINDINGS: Although person-centred care and patient advocacy were core values for many of the participants, strict hierarchies, age-based seniority, and concerns about offending a colleague or causing team disharmony impeded their use of assertive communication. Novice nurses were particularly reluctant to speak up because of their perception of having limited knowledge and experience. CONCLUSION: This study identified Japanese nurses' behavioural, normative, and control beliefs in relation to assertive communication. The findings will be used to inform the development of a culturally appropriate assertiveness communication training program for Japanese nurses and nursing students.

The effect of a community mental health training program for multidisciplinary staff.

BACKGROUND: Primary health workers play a critical role in providing health education to people with mental disorders. In China community health workers working with people with mental health problems lack experience and training in this area. Additionally, coordination between hospital and community staff is not well established. The aim of this study was to provide an interdisciplinary community mental health training program and to evaluate the effect of the training on staff knowledge about mental health and confidence in their roles. METHODS: A three-day community mental health training program was offered specifically for interdisciplinary mental health professionals. Using a one-group pre-test post-test design, participants completed a self-assessment of mental health concepts and program evaluation which included asking participants to rate their satisfaction using a five-point Likert scale and to respond to open-ended questions. RESULTS: Forty-eight participants including health professionals from colleges, hospital and community health centers were recruited. Only 8.7% of participants had ever received community mental health training. Post-test evaluation demonstrated improvements in knowledge, and most participants were very satisfied with the program. CONCLUSION: The findings indicate that this brief interdisciplinary training program had a positive effect in improving knowledge about community mental health concepts and confidence in dealing with people with mental health disorders for multidisciplinary staff working in primary health care areas.

Increasing undergraduate nursing students' cultural competence: an evaluation study.

BACKGROUND: Cultural competence has become increasingly important for Chinese health professionals because of internationalization and the opening up of China to overseas visitors and business as well as a growing awareness of the needs of minority groups within China. This study aimed to evaluate a workshop designed to improve cultural competence among Chinese undergraduate nursing students. METHODS: A one-group pretest and posttest design was applied. The intervention was a one-day workshop based on transformative learning theory using a variety of teaching strategies. Forty undergraduate nursing students from a university in Wuhan, China selected by convenient sampling received the intervention. Data were collected before the intervention (T1), immediately after the intervention (T2), and 1 month (T3) and 3 months (T4) following the intervention through the Chinese version of Cultural Competence Inventory for Nurses (CCIN). A researcher-designed evaluation form including open-ended questions was also used. RESULTS: Participants' scores by CCIN increased significantly in the total score (p < .001) as well as the components of cultural awareness (p = .003), cultural knowledge (p < .001), cultural understanding (p = .007) and cultural skills (p < .001), but not in cultural respect. This improvement maintained at T3 and T4. Overall, participants were satisfied with the workshop, and the qualitative results supported the effects of this intervention. CONCLUSIONS: The one-day workshop was effective in improving nursing students' cultural competence. Replication or further refinement of this workshop is recommended for future research among additional nursing students with diverse backgrounds.

Cultural factors influencing Japanese nurses' assertive communication: Part 2 - hierarchy and power.

Hierarchy and power characterize health-care relationships around the world, constituting a barrier to assertive communication and a risk to patient safety. This issue is more problematic and complex in countries such as Japan, where deep-seated cultural values related to hierarchy and power persist. The current paper is the second of two that present the findings from a study exploring Japanese nurses' views and experiences of how cultural values impact assertive communication for health-care professionals. We conducted semistructured interviews with 23 registered nurses, following which data were analyzed using directed content analysis. Two overarching themes emerged from the analysis: hierarchy/power and collectivism. In the present study, we focus on cultural values related to hierarchy and power, including differences in professional status, gender imbalance, seniority/generation gap, bullying, and humility/modesty. The findings from our research provide meaningful insights into how Japanese cultural values influence and constrain nurses' communication and speaking up behaviors, and can be used to inform educational programs designed to teach assertiveness skills.

Cultural factors influencing Japanese nurses' assertive communication. Part 1: Collectivism.

Culture influences the way health-care professionals communicate with each other and their ability to relate to colleagues in an assertive manner. Cultural barriers can also make it difficult for nurses to speak up even when they have concerns about patient safety. An understanding of the potential impact of cultural factors is therefore needed when developing assertiveness communication training programs. This paper presents the findings from a study that explored Japanese nurses' perceptions of how culture and values impact assertive communication in health care. Semistructured interviews with 23 registered nurses were undertaken, and data were analyzed using directed content analysis. Two major themes were identified: collectivism and hierarchy/power. In the present study, we discuss the cultural values related to collectivism that included four categories of "wa" (harmony), "uchi to soto" (inside and outside), implicit communication/ambiguity, and "nemawashi" (groundwork). The findings highlight the impact of culture on nurses' assertive communication behaviors and can be used to inform the design of culturally-appropriate assertiveness communication training programs for Japanese nurses working both within their own country or internationally.

Incidence, Type, Related Factors, and Effect of Workplace Violence on Mental Health Nurses: A Cross-sectional Survey.

OBJECTIVE: Workplace violence and its impact on mental health nurses have yet to be thoroughly explored in China. This study aims to investigate the incidence, type, related factors, and effects of workplace violence on mental health nurses as well as identifying coping strategies. METHODS: A researcher - designed workplace violence questionnaire and the Maslach Burnout Inventory-General Survey were distributed to nurses at a mental health hospital in Wuhan, China. RESULTS: Most nurses reported a high incidence of workplace violence (94.6%) in the past year ranging from verbal aggression, sexual harassment, to physical attack. The forms of violence significantly correlated with each other (r>0.5, p=0.000). Working on the psychiatric intensive care unit for adult males and being a male nurse placed nurses at significantly higher risk for workplace violence. Providing routine treatment, caring for male patients, and working the night shift increased the risk of sexual harassment. Nurses who believed that workplace violence was preventable experienced a significantly lower incidence of violence. Burnout levels of the mental health nurses were relatively mild, but increased with age, professional title, years of employment and frequency of workplace violence. CONCLUSION: The incidence of workplace violence among mental health nurses is common, and its frequency is correlated with nurses' level of burnout. Management and clinical nurses should work together on an organization-wide strategy targeting the major identified risk areas to reduce the incidence of workplace violence and minimize its impact on nurses.

Translation and Adaptation of a Nursing Swearing Impact Questionnaire Into Chinese.

BACKGROUND: Verbal aggression and swearing are the most frequently encountered violence in the health care industry. Nurses are the most frequent victims. Not known is the incidence and impact of swearing against nurses in China. OBJECTIVES: (a) Develop a Chinese version of the Nursing Swearing Impact Questionnaire; (b) report the preliminary findings from the use of the tool. METHOD: Using a translation-back translation procedure, focus groups and expert review, followed by a survey of 32 participants. RESULTS: The Chinese version of the Nursing Swearing Impact Questionnaire has been developed, and cultural differences and different attitudes toward verbal aggression and swearing in disparate groups and workplaces have been highlighted. CONCLUSIONS: This is the first Chinese tool to research nurses' perspectives and experiences of swearing in the workplace. Nurses in China face serious challenges, and the impact of swearing on nurses requires more attention.