This study aims to unveil the process of whistleblowing. Two nursing staff members who worked in a psychiatric hospital convicted of large-scale wrongdoing were interviewed. Data were analyzed using a modified grounded theory approach. Analysis of the interviews demonstrated that they did not decide to whistleblow when they were suspicious or had an awareness of wrongdoing. They continued to work, driven by appreciation, affection, and a sense of duty. Their decision to whistleblow was ultimately motivated by firm conviction. Shortly after whistleblowing, wavering emotions were observed, consisting of a guilty conscience, fear of retribution, and pride, which subsequently transformed to stable emotions containing a sense of relief and regret for delayed action. It is necessary for nurses to recognize that their professional responsibility is primarily to patients, not to organizations. Nurses should also have professional judgment about appropriate allegiance and actions.

The Mental Health Act in Japan was enacted in 1987. This study aims to determine whether the act has been effective in protecting patient rights by delineating the content and trends of patient rights violations at psychiatric hospitals through an analysis of newspaper reports. An analysis of 924 newspaper articles found 39 hospitals involved in patient rights violations. The results show that violations of patient rights have continued to occur after the implementation of the act. The reasons: for-profit policy of hospitals, a defective oversight system, and a lack of knowledge about the act by medical staff.

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