Japanese psychiatric mental health systems are being steadily improved. Psychiatric nurses’ attitude towards strengths of persons with mental disability is critical in order to promote de-institutionalization of patients. However, nurses’ attitudes, particularly their Strengths-Oriented Attitude (SOA) has not been well studied and explained. The purpose of this study was to clarify the SOA of nurses working in psychiatric hospitals in Japan. There were 1148 Psychiatric Registered Nurses (PRN) and Psychiatric Practical Nurses (PPN) employed at 17 psychiatric hospitals in Japan who consented to participate in the study. The self-administered questionnaire was mailed and returned between October 2013 and January 2014. The subjects’ SOA was evaluated using the Strengths-Oriented Attitude Inventory (SOAI) developed by the authors based on the work by Rapp and Goscha. The actual SOA and its relationship to individual characteristics were also analyzed to clarify the SOAI. Factor analysis revealed four components of the SOAI: Factor 1 = “Nursing practice based on the assessment which focused on social resources”; Factor 2 = “Nursing practice based on the holistic assessment of person with mental disability”; Factor 3 = “Support in community which respected the person’s way of living”; and Factor 4 = “Emphasize of the strengths of individual with mental disability.” Results indicated a high orientation toward Factors 2 and 4, but a low orientation toward Factors 1 and 3. There were no significant differences between age, years of psychiatric nursing experience, academic background, and subjects’ SOA. However, differences were observed in gender, current workplace, work position, type of license, and work experience. The subjects showed low orientation toward social resources and respected the patient’s way of life. Nurses working in psychiatric mental health institutions should receive continuing education courses designed to increase their orientation toward Factors 1 and 3.
Since the beginning of the health care de-institutionalization movement in the mid-1950s, the role of psychiatric hospitals has changed [
Along with changes in psychiatric medicine, the focus has turned from the traditional medical model emphasizing the problems and deficiencies of persons with mental disability to one that highlights the importance of person’s strengths, abilities, and resources [
Until recently, psychiatric health care in Japan was characterized by a paucity of physician and nursing personnel and the largest number of psychiatric-ward beds worldwide [
In 2008, the total number of psychiatric hospitals in Japan was 1637 hospitals, and this number was reduced to 1622 hospitals in 2012. There were 27.2 psychiatric beds per 10,000 persons in 2008, and this average was reduced to 26.5 in 2012. The average length of stay in psychiatric hospitals in 2008 was 313 days, and in 2012 was 292 days [
Progress towards de-institutionalization requires both the promotion of team medical care [
The nurse theorist Peplau [
Clinically, data that represent patients’ strengths can be important knowledge for nurses [
Recently, strengths-based nursing care has been introduced as a new paradigm for nursing and health care [
In Japan, a concept analyses of strength [
The purpose of this study was to clarify the strengths-oriented attitude of nurses working in psychiatric hospitals in Japan.
The subjects of this survey were 1148 PRN and PPN employed at 17 psychiatric hospitals in Japan whose consent had been obtained. The data were collected from October 2013 to January 2014. Psychiatric nurses who had agreed to participate in the survey were mailed survey-request documents describing the study and survey forms. Responses were obtained using a self-administered, anonymous form. The subjects completed questionnaire items assessing baseline demographic data and the SOA.
Individual characteristics, such as gender, age, years worked, workplace, work position, type of license, academic background, work experience, and psychiatric-care experience were surveyed. The subjects’ SOA was evaluated using the SOAI. The SOAI was developed by us authors based on the work of Rapp and Goscha [
Cronbach’s alpha coefficient correlation and an exploratory factor analysis were used for evaluating the SOAI. A rotation of factor loadings was conducted using the Equamax Method. Kaiser-Meyer-Olkin and the Bartlett’s test of Sphericity were used to assess the validity of the SOAI. The number of factors were decided by the Kaiser criterion, and factor loadings of less than 0.40 were omitted to improve clarity.
To obtain an overall picture of the SOAI, the mean SOAI total score and mean factor points (MFP) for each subscale were calculated. The total score and each MFP were categorized every 0.5 point to create frequency distributions.
The actual state of the SOA and its relationships to individual characteristics were analyzed. Pearson correlations were calculated to assess associations between the mean SOAI total score, MFP, age, and years of psychiatric nursing experience. A correlation was defined as evident when the coefficient was 0.4 or higher.
The relationships between individual characteristics, the mean SOAI total score, and each MFP were analyzed. Groups were created based on gender, workplace, work position, work experience, psychiatric-care experience, and experience in other departments. Homoscedasticity was tested with Levene’s test followed by either Welch’s t-test or Student’s t-test. In addition, the relationships between SOAI, type of license, and academic background were analyzed. Data were analyzed using analysis of variance (ANOVA) and post-hoc tests of latent classes, multiple comparisons, and Tukey’s honest significant difference (HSD) test. Missing value was excluded from each data analysis. For all analyses, the statistical-significance level was 0.05. All statistical analyses were performed using the SPSS for Windows software (version 20.0; SPSS Inc., Chicago, IL).
This research was approved by the University of Tokushima Hospital Clinical Study Ethical Review Board (approval number: 1201). No harm to the subjects could be identified. Return of the survey implied that the subjects gave consent. The subjects were notified that privacy would be protected; only aggregate data are used in reporting the findings.
The subjects were 1148 PRN and PPN in Japan; 1055 surveys were returned (response rate = 91.9%). Due to incomplete returns of the SOAI, data from only 984 subjects were analyzed: mean age = 44.7 ± 11.0 (range = 20 - 70; n = 961) years; 315 men (32.0%) and 669 women (68.0%); 643 PRN (65.3%) and 341 PPN (34.7%). They had 13.8 ± 9.2 (range 0.0 - 43.0; n = 966) years of experience in psychiatric departments. There were 533 subjects (54.2%) with experience in other departments (mean = 8.8 ± 7.6 years; range = 0.3 - 37.0; n = 496). Finally, the subjects had 18.2 ± 10.4 years (range = 0.0 - 47.0; n = 936) of nursing experience.
Rapp and Goscha identified six principles and strengths assessments, its principle, namely: (1) “People with psychiatric disabilities can recover, reclaim, and transform their lives”. (2) “The focus is on individual strengths rather than deficits”. (3) “The community is viewed as an oasis of resources”. (4) “The client is the director of the helping process”. (5) “The case manager-client relationship is primary and essential”. (6) “The primary setting for the work is the community”. Strengths assessment is organized in seven life domains, namely; Daily living, Finances, Work/education, Social network, Recreation, Overall health, and Spirituality [
Result of the exploratory factor analysis, among the six principles and strengths assessments, all strengths assessments items were included, but Principle (1) was excluded by factor loadings of less than 0.40. A relation between “principles and strengths assessments” and the SOAI is indicated: Principle (2), and SOAI items 4 and 5; Principle (3) and (6), and item 8 of SOAI; Principle (4), with item 6 of SOAI; Principle (5), and item 7 of SOAI. In the strengths assessments: Daily living was related to items 18 and 20 of SOAI; Finances with item 22 of SOAI; Work/education with item 23 of SOAI; Social network with items 15, 19 and 21 of SOAI; Recreation with item 24 of SOAI; Overall health, was related with items 10, 16 and 17 of SOAI; and Spirituality with item 9.
As shown in
The Kaiser-Meyer-Olkin value was 0.925, and the Bartlett’s test of Sphericity was significant at P < 0.001. The factor analysis revealed four components of the SOA: Factor 1 = “Nursing practice based on the assessment which focused on social resources,” Factor 2 = “Nursing practice based on the holistic assessment of person with mental disability,” Factor 3 = “Support in community which respected the person’s way of living,” and Factor 4 = “Emphasize of the strengths of individual with mental disability,” The resulting scales had an internal consistency (Cronbach’s alpha) of 0.872, 0.876, 0.825, and 0.788, respectively, and the total scale had an internal consistency of 0.903, accounting for a total of 50.7% of the variance.
Items | Factor loadings | ||||
---|---|---|---|---|---|
Factor 1 | Factor 2 | Factor 3 | Factor 4 | ||
Factor 1: Nursing practice based on the assessment which focused on social resources. | |||||
23 | Nurses assess persons with mental disability and provide care with emphasis on current job or schoolwork. | 0.768 | 0.143 | 0.026 | 0.023 |
20 | Nurses assess mentally disabled person and provides care with emphasis on his/her housing. | 0.765 | 0.276 | 0.069 | −0.007 |
22 | Nurses assess persons with mental disability and provide care with emphasis on his/her economic situation including insurance. | 0.661 | 0.323 | 0.081 | 0.074 |
25 | Nurses assess persons with mental disability and provide care with emphasis on necessary social resource. | 0.585 | 0.403 | 0.169 | 0.146 |
24 | Nurses assess persons with mental disability and provide care with emphasis on his/her hope. | 0.534 | 0.360 | 0.174 | 0.151 |
21 | Nurses assess persons with mental disability and provide care with emphasis on his/her human relations. | 0.529 | 0.489 | 0.155 | 0.082 |
Factor 2: Nursing practice based on the holistic assessment of person with mental disability. | |||||
17 | Nurses assess persons with mental disability and provide care with emphasis on mental health conditions. | 0.203 | 0.823 | 0.120 | 0.172 |
18 | Nurses assess persons with mental disability and provide care with emphasis on ability to perform activities of daily life. | 0.342 | 0.713 | 0.138 | 0.190 |
16 | Nurses assess persons with mental disability and provide care with emphasis on physical conditions. | 0.333 | 0.654 | 0.086 | 0.067 |
19 | Nurses assess persons with mental disability and provide care with emphasis on social ability. | 0.466 | 0.639 | 0.144 | 0.081 |
Factor 3: Support in community which respected the person’s way of living. | |||||
9 | Behaviors of person with mental disability is affected by their own life histories, current social relationships, and goals in life. | 0.058 | 0.141 | 0.553 | 0.308 |
10 | The nurses’ role is to maintain a healthy lifestyle for each person. | 0.049 | 0.110 | 0.532 | 0.316 |
8 | The main place of supporting persons with mental disability is a community. | 0.154 | 0.013 | 0.532 | 0.214 |
15 | The availability of peer support is important for person with mental disability. | 0.162 | 0.209 | 0.527 | 0.233 |
12 | Knowing a person’s inner world, intentionally leads to a nursing intervention illustrating the person’s ways of living to maintain and improve the person’s quality of living in the community | 0.071 | 0.111 | 0.518 | 0.434 |
11 | Nurse have to improve patient’s ability to do self-management and self-care. | 0.048 | 0.194 | 0.487 | 0.335 |
13 | The innovations of the functional capabilities of psychiatric hospitals are required for deinstitutionalization. | 0.057 | 0.145 | 0.476 | 0.331 |
6 | In the process of providing care, persons with mental disability is a decision maker. | 0.175 | 0.096 | 0.413 | 0.288 |
14 | Different care providers have different appreciation for providing care for mentally disabled persons, and the difference is important for team care. | 0.113 | 0.153 | 0.408 | 0.147 |
Factor 4: Emphasize on the strengths of individuals with mental disability. | |||||
5 | To achieve recovery that is desired by a person with mental disability, nurses have to care for them by bringing out their own abilities with help from health care and welfare specialists, family members, and community. | 0.035 | 0.101 | 0.179 | 0.797 |
4 | It is important to support persons with mental disability so that they can bring up their own ability that they already have. | 0.061 | 0.116 | 0.262 | 0.728 |
7 | In the care process, the human relationship between nurse and nursed is fundamental. | 0.039 | 0.098 | 0.449 | 0.523 |
Eigen value | 3.120 | 2.966 | 2.677 | 2.382 | |
Variance, % | 14.181 | 13.482 | 12.169 | 10.827 | |
Cumulative variance, % | 14.181 | 27.663 | 39.831 | 50.659 | |
Cronbach’s alpha | 0.872 | 0.876 | 0.825 | 0.788 |
Notes: Cronbach’s alpha coefficient (α) for the total score was 0.903. A number of left italics is the question number. Initial items were 25, three items’ (1, 2 and 3) factor loading was less than 0.4, those were removed.
n (%) | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|
Mean | (SD) | point | 1.00 - 1.49 | 1.50 - 1.99 | 2.00 - 2.49 | 2.50 - 2.99 | 3.00 - 3.49 | 3.50 - 3.99 | 4.00 | |
SOAI total score | 2.98 | (0.28) | 0 (0) | 1 (0.1) | 33 (3.4) | 438 (44.5) | 458 (46.5) | 49 (5.0) | 5 (0.5) | |
Factor 1 | 2.81 | (0.41) | 5 (0.5) | 8 (0.8) | 152 (15.4) | 260 (26.4) | 515 (52.3) | 29 (2.9) | 15 (1.5) | |
Factor 2 | 2.98 | (0.37) | 5 (0.5) | 1 (0.1) | 43 (4.4) | 119 (12.1) | 733 (74.5) | 39 (4.0) | 44 (4.5) | |
Factor 3 | 3.02 | (0.31) | 0 (0) | 0 (0) | 32 (3.3) | 336 (34.1) | 535 (54.4) | 63 (6.4) | 18 (1.8) | |
Factor 4 | 3.20 | (0.40) | 1 (0.1) | 0 (0) | 13 (1.3) | 49 (5.0) | 699 (71.0) | 106 (10.8) | 116 (11.8) |
Abbreviations: SD = standard deviations, Factor 1, Nursing practice based on the assessment which focused on social resources; Factor 2, Nursing practice based on the holistic assessment of person with mental disability; Factor 3, Support in community which respected the person’s way of living; Factor 4, Emphasize of the strengths of individual with mental disability.
n | SOAI total score | Factor 1 | Factor 2 | Factor 3 | Factor 4 | |
---|---|---|---|---|---|---|
Age | 961 | −0.123 | −0.036 | −0.062 | −0.156 | −0.107 |
Psychiatric nursing experience | 966 | −0.051 | 0.005 | −0.023 | −0.086 | −0.038 |
Nursing experience | 936 | −0.085 | −0.025 | −0.048 | −0.108 | −0.070 |
Abbreviations: SOAI, Strengths Oriented Attitude Inventory; Factor 1, Nursing practice based on the assessment which focused on social resources; Factor 2, Nursing practice based on the holistic assessment of person with mental disability; Factor 3, Support in community which respected the person’s way of living; Factor 4, Emphasize of the strengths of individual with mental disability.
The mean SOAI total score (P = 0.005) and the number of MFP of Factors 3 (P = 0.007) and 4 (P < 0.001) were significantly higher for managers than staff. The mean SOAI total score (P < 0.001) and the number of MFP of Factors 2 (P = 0.001), 3 (P < 0.001), and 4 (P < 0.001) were significantly lower for those who had a practice nurse (PN) license than those who had a registered nurse (RN) license or both a RN and PN license.
The subjects’ had varied psychiatric-work experience. For example, 84 nurses (8.5%) had experience in home- visit nursing, 75 (7.6%) in day-care nursing, 257 (26.1%) in physical-complication wards, 682 (69.3%) in acute wards, 863 (87.7%) in chronic wards, and 152 (15.4%) in outpatient wards. In addition, the content of the subjects’ psychiatric-care experience differed; 91 (9.2%) had psycho-education, 251 (25.5%) had discharge facilitation, 326 (33.1%) had Social Skills Training (SST), and 25 (2.5%) had team approaches.
There were significant differences between work experience, psychiatric-care experience, and the SOAI score, as shown in
The mean SOAI total score (P < 0.001) and the number of MFP of Factors 1 (P = 0.001), 2 (P = 0.007), 3 (P = 0.001), and 4 (P = 0.004) were significantly higher for those who had experience in psycho-education than those who did not. The mean SOAI total score (P = 0.002) and the number of MFP of Factors 1 (P = 0.014),
SOAI Total score | Post hoc test | Factor 1 | Post hoc test | Factor 2 | Post hoc test | Factor 3 | Post hoc test | Factor 4 | Post hoc test | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
n | Mean | SD | P | Mean | SD | P | Mean | SD | P | Mean | SD | P | Mean | SD | P | ||||||
Gendera) | |||||||||||||||||||||
Men | 315 | 3.00 | 0.29 | N.S. | 2.80 | 0.44 | N.S. | 3.01 | 0.40 | N.S. | 3.05 | 0.33 | * | 3.22 | 0.41 | N.S. | |||||
Women | 669 | 2.97 | 0.27 | 2.82 | 0.39 | 2.97 | 0.36 | 3.01 | 0.30 | 3.18 | 0.39 | ||||||||||
Work placea), c) | |||||||||||||||||||||
Ward | 890 | 2.97 | 0.27 | ** | 2.80 | 0.41 | ** | 2.98 | 0.37 | N.S. | 3.02 | 0.31 | ** | 3.19 | 0.39 | N.S. | |||||
Community | 69 | 3.08 | 0.32 | 2.93 | 0.38 | 3.04 | 0.38 | 3.12 | 0.33 | 3.29 | 0.45 | ||||||||||
Work positiona), c) | |||||||||||||||||||||
Staff | 819 | 2.97 | 0.29 | ** | 2.81 | 0.41 | N.S. | 2.98 | 0.38 | N.S. | 3.01 | 0.32 | ** | 3.17 | 0.39 | *** | |||||
Manager | 162 | 3.04 | 0.24 | 2.85 | 0.37 | 3.02 | 0.33 | 3.09 | 0.29 | 3.31 | 0.42 | ||||||||||
Type of licenseb) | |||||||||||||||||||||
RN | 354 | 3.00 | 0.25 | *** | ** | 2.82 | 0.38 | N.S. | 3.01 | 0.32 | ** | ** | 3.04 | 0.30 | *** | ** | 3.21 | 0.39 | *** | ** | |
RN and PN | 289 | 3.03 | 0.29 | *** | 2.85 | 0.41 | 3.02 | 0.40 | ** | 3.07 | 0.33 | *** | 3.27 | 0.41 | *** | ||||||
PN | 341 | 2.93 | 0.29 | 2.77 | 0.43 | 2.92 | 0.39 | 2.97 | 0.31 | 3.12 | 0.39 | ||||||||||
Academic backgroundb), c) | |||||||||||||||||||||
Technical college | 835 | 2.98 | 0.28 | N.S. | 2.82 | 0.40 | N.S. | 2.99 | 0.37 | N.S. | 3.03 | 0.31 | N.S. | 3.20 | 0.40 | N.S. | |||||
Junior college | 50 | 2.94 | 0.26 | 2.78 | 0.39 | 2.97 | 0.34 | 2.98 | 0.33 | 3.14 | 0.40 | ||||||||||
College etc. | 48 | 3.02 | 0.34 | 2.76 | 0.54 | 2.98 | 0.47 | 3.11 | 0.35 | 3.29 | 0.46 | ||||||||||
Experience in other departmentsa), c) | |||||||||||||||||||||
Yes | 533 | 2.98 | 0.28 | N.S. | 2.81 | 0.40 | N.S. | 2.99 | 0.37 | N.S. | 3.02 | 0.31 | N.S. | 3.19 | 0.40 | N.S. | |||||
No | 444 | 2.99 | 0.28 | 2.81 | 0.41 | 2.98 | 0.38 | 3.03 | 0.32 | 3.21 | 0.39 |
Notes: *P < 0.05, **P < 0.01, ***P < 0.001, a)Welch’s t-test or Student’s t-test, b)ANOVA with Tukey’s HSD test, and c) Others and unknown data were omitted from the data analysis. Abbreviations: N.S. = Not Significant, ANOVA = analysis of variance; SD = standard deviations; SOAI, Strengths Oriented Attitude Inventory; RN, Registered Nurse; PN, Practicical Nurse; College etc., college and graduate school. Factor 1, Nursing practice based on the assessment which focused on social resources; Factor 2, Nursing practice based on the holistic assessment of person with mental disability; Factor 3, Support in community which respected the person’s way of living; Factor 4, Emphasize of the strengths of individual with mental disability.
2 (P = 0.018), 3 (P = 0.040), and 4 (P = 0.002) were significantly higher for those who had experience in discharge facilitation than those who did not.
The mean SOAI total score (P = 0.002) and the number of MFP of Factors 3 (P = 0.008) and 4 (P < 0.001) were significantly higher for those who had experience in SST than those who did not, and the SOAI total score (P = 0.002) and the number of MFP of Factor 1 (P = 0.019) and 2 (P = 0.007) were significantly higher for those who had experience in team approaches than those who did not.
This study found no significant differences between academic background, experience in other departments, work experiences (chronic ward or outpatient), and SOAI score. There were no correlations between age, years of psychiatric nursing experience and SOAI score. However, differences were observed for gender, workplace, work position, type of license, work experience (home-visiting, day-care, physical complications) and psychiatric-care experience (psycho-education, discharge facilitation, SST, and team approach). Score in Factor 3 “Support in community which respected the person’s way of living” was significantly higher among male Japanese
SOAI Total score | Factor 1 | Factor 2 | Factor 3 | Factor 4 | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
n | Mean | SD | P | Mean | SD | P | Mean | SD | P | Mean | SD | P | Mean | SD | P | ||
Work experience | |||||||||||||||||
Home-visiting | Yes | 84 | 3.06 | 0.27 | ** | 2.87 | 0.41 | N.S. | 3.01 | 0.38 | N.S. | 3.14 | 0.31 | *** | 3.32 | 0.43 | ** |
No | 896 | 2.98 | 0.28 | 2.81 | 0.41 | 2.98 | 0.37 | 3.01 | 0.31 | 3.19 | 0.39 | ||||||
Day-care | Yes | 75 | 3.05 | 0.28 | * | 2.90 | 0.37 | N.S. | 2.99 | 0.34 | N.S. | 3.11 | 0.32 | * | 3.25 | 0.41 | N.S. |
No | 905 | 2.98 | 0.28 | 2.81 | 0.41 | 2.98 | 0.37 | 3.02 | 0.31 | 3.19 | 0.40 | ||||||
Physical complications | Yes | 257 | 2.96 | 0.28 | N.S. | 2.76 | 0.43 | * | 2.96 | 0.42 | N.S. | 3.01 | 0.30 | N.S. | 3.18 | 0.37 | N.S. |
No | 723 | 2.99 | 0.28 | 2.83 | 0.40 | 2.99 | 0.35 | 3.03 | 0.32 | 3.20 | 0.41 | ||||||
Acute ward | Yes | 682 | 2.99 | 0.27 | N.S. | 2.82 | 0.40 | N.S. | 2.99 | 0.38 | N.S. | 3.03 | 0.31 | N.S. | 3.22 | 0.41 | * |
No | 298 | 2.97 | 0.29 | 2.80 | 0.42 | 2.97 | 0.36 | 3.01 | 0.32 | 3.15 | 0.37 | ||||||
Chronic ward | Yes | 863 | 2.98 | 0.27 | N.S. | 2.81 | 0.40 | N.S. | 2.98 | 0.36 | N.S. | 3.02 | 0.32 | N.S. | 3.20 | 0.39 | N.S. |
No | 117 | 3.00 | 0.32 | 2.83 | 0.47 | 3.02 | 0.45 | 3.04 | 0.31 | 3.20 | 0.46 | ||||||
Outpatient | Yes | 152 | 3.00 | 0.28 | N.S. | 2.84 | 0.40 | N.S. | 2.95 | 0.37 | N.S. | 3.05 | 0.31 | N.S. | 3.24 | 0.42 | N.S. |
No | 828 | 2.98 | 0.28 | 2.81 | 0.41 | 2.99 | 0.37 | 3.02 | 0.32 | 3.19 | 0.39 | ||||||
Psychiatric-care experience | |||||||||||||||||
Psycho- education | Yes | 91 | 3.10 | 0.29 | *** | 2.94 | 0.37 | ** | 3.08 | 0.37 | ** | 3.14 | 0.36 | ** | 3.31 | 0.42 | ** |
No | 893 | 2.97 | 0.28 | 2.80 | 0.41 | 2.97 | 0.37 | 3.01 | 0.31 | 3.18 | 0.39 | ||||||
Discharge facilitation | Yes | 251 | 3.03 | 0.26 | ** | 2.87 | 0.39 | * | 3.03 | 0.34 | * | 3.06 | 0.33 | * | 3.27 | 0.41 | ** |
No | 733 | 2.97 | 0.28 | 2.79 | 0.41 | 2.97 | 0.38 | 3.01 | 0.31 | 3.17 | 0.39 | ||||||
Social skills training | Yes | 326 | 3.02 | 0.28 | ** | 2.84 | 0.42 | N.S. | 3.01 | 0.38 | N.S. | 3.06 | 0.32 | ** | 3.27 | 0.40 | *** |
No | 658 | 2.96 | 0.28 | 2.80 | 0.40 | 2.97 | 0.37 | 3.01 | 0.31 | 3.16 | 0.39 | ||||||
Team approach | Yes | 25 | 3.15 | 0.34 | ** | 3.00 | 0.47 | * | 3.18 | 0.38 | ** | 3.18 | 0.39 | N.S. | 3.32 | 0.40 | N.S. |
No | 939 | 2.98 | 0.28 | 2.81 | 0.40 | 2.98 | 0.37 | 3.02 | 0.31 | 3.19 | 0.40 |
Notes: *P < 0.05, **P < 0.01, ***P < 0.001, N.S. = not significant. Welch’s t-test or Student’s t-test. Unknown data were omitted from the data analysis. Abbreviations: SD = standard deviations; SOAI, Strengths Oriented Attitude Inventory; Factor 1, Nursing practice based on the assessment which focused on social resources; Factor 2, Nursing practice based on the holistic assessment of person with mental disability; Factor 3, Support in community which respected the person’s way of living; Factor 4, Emphasize of the strengths of individual with mental disability.
PRN and PPN than among female. Hence, it was thought need to conduct further study to confirm gender differences and relationship between subjects’ backgrounds and SOA.
In addition, it appears to be not the length of experience that is important to the SOA of PRN and PPN, but kind of job component and experience they accumulated in clinical settings. Job components were significantly related to work position and licenses type of nurse.
For work positions, for the mean SOAI total scores and the number of MFP of Factors 3 and 4 were significantly higher for managers than staff. Compared with staff who have ample opportunities to interact with persons with mental disability in a one-to-one manner, managers are able to judge their strengths more calmly as a result of having had fewer such opportunities. Moreover, managers have more opportunities to work with other professionals and nurses in other wards [
The mean SOAI total score and number of MFP of Factors 2, 3 and 4 were significantly lower for those who had a PN license than those who had an RN license or both RN and PN licenses. This indicates the influence of the curricula in nursing education. Specifically, PN education emphasizes the various views and personalities of sick people and their families. PNs are taught fundamental skills that enable the ethical practicing of nursing. In contrast, RN education emphasizes nurses’ role in health maintenance and improvement, disease prevention, and health recovery. RNs learn fundamental skills that enable them to respond to different health conditions and changes in these conditions. RNs are also taught to understand their role in relation to that of other professionals in the health, medical, and welfare systems; they are also taught basic skills for cooperating and working with other professionals. As professionals, they practice basic skills that enable them to independently update their knowledge regarding the latest academic and technologic developments [
There were significant differences observed regarding workplaces and psychiatric-care experience with respect to PRN and PPN. The SOAI total score and the number of MFP of Factors 1 and 3 were significantly higher for those who were working in the community than those who were working in hospital wards. PRN and PPN who were working in the community were collaborating with other professionals, such as public-health nurses and social workers. Thus, they were able to perform social-based assessments and provide community- based lifestyle support.
Regarding different workplaces, the SOAI total score and the number of MFP of Factors 3 and 4 were significantly higher for those who had experience in home-visit nursing than those who did not, and the mean SOAI total score and the number of MFP of Factor 3 was significantly higher for those who had experience in day-care nursing than those who did not. However, there was no significant difference based on outpatient experience. Home-visit and day-care nurses provided support at locations that were closer to their patients’ residences than did outpatient nurses, and this experience appears to have affected their respective strengths-orientated attitudes.
Regarding psychiatric-care experience, PRN and PPN with psycho-education and discharge-facilitation experience had significantly higher scores on all items compared to those without such experience. Further, those who had experience in SST and team approaches had significantly higher SOAI total scores than those without these experiences. Because a strengths viewpoint is already included in these forms of support, developing them in actual practice may be linked to improving the strengths orientation of PRN and PPN.
The SOA among Japanese PRN and PPN showed a high orientation toward Factors 2 and 4, but a low orientation toward Factors 1 and 3 as assessed by frequency distribution. If nurses provided care with an emphasis on social resources and respect for the patient’s way of living through multidisciplinary cooperation, it would likely increase the overall SOA by way of the nurses’ professional experiences.
The results of this study indicate that two measures could help increase the SOA of PRN and PPN. The first is to reinforce education about Factors 1 (“Nursing practice based on the assessment which focused on social resources”) and 3 (“Support in community which respected the person’s way of living”) for PPN staff and working staff in hospital wards. The second is to strengthen staff-development systems and the variety of duty assignments so that PRN and PPN gain direct experience with psycho-education, discharge planning, and home- visit nursing.
Rapp and Goscha’s “Strengths model” focused on the “strengths mode of practice, on helping people, not as patients or clients, but as individuals” [
The SOAI has limited reliability. As SOAI was developed by the researchers based on Rapp and Goscha’s six principles and strengths assessments items, its psychometric testing is critical establishing its ability to predict SOA. With the Japanese sample, the study provides an initial investigation into its ability to predict outcomes in a particular focused group. The SOAI has not been studied in other countries with different practice processes of psychiatric management. It is envisioned to be tested soon.
It is necessary to conduct further psychometric testing to increase the reliability and validity of the SOAI. Also, it will be necessary to compare psychiatric nurses’ SOA using cross-national research considering culture and practice similarities and differences, to clarify inter-professional differences, and to examine the relationship between SOA and care abilities of psychiatric nurses.
The aim of this study was to clarify the SOA among PRN and PPN in psychiatric hospitals in Japan. These subjects showed a low orientation toward social resources and respected the patients’ way of living. In addition, there were significant differences in the type of license, work position, work experience, and psychiatric-care experience. Nurses working in psychiatric support situations should receive continuing education designed to increase their orientation toward Factors 1 and 3.
We would like to express our deep gratitude to the Japanese psychiatric nurses who participated in this study, our family members, and academic supervisors. In particular, we appreciate clinicians: Dr. Kazushi Mifune, MD, PhD (Mifune Hospital) and Dr. Kanji Hikasa, MD, PhD, helping this study.
All of the authors declare that they have no direct conflicts of interest or grant support that is directly related to the content of the study.