Nursing Philosophy of community mental health nurses in Japan: A qualitative, descriptive study

Abstract

The present study reports the findings of a qualitative, descriptive study that sought to clarify nursing philosophy for community mental health nurses (CMHN) working at independent psychiatric home-visit nursing agencies in Japan. We carried out participant observation and semistructured interviews with 13 CMHN in rural and urban areas. We identified eight subthemes and three higher-order themes based on these subthemes. CMHN embraced a nursing philosophy in which they: (i) have respect for consumers' ways of life and their self-realization; (ii) find harmony between view of life and work; and (iii) build communities where residents support each other beyond their roles. Together, these themes constitute a valuable nursing philosophy that supports the recovery of people with mental illness. The themes could also help educate professionals about principles and meanings relevant to recovery, which are regarded as key to changing the professional's care paradigm from a biomedical model to a recovery model.

Experiences of community mental health nurses in Japan as the basis of their nursing philosophies

“…The CMHNs’ motivation to face issues inherent in Japanese psychiatric healthcare systems and the difficulties they observe in consumers’ lives may come from their own lived experiences, which could be regarded as a lifelong challenge for them. This phenomenon may be linked to results revealing the harmony between views of life and work identified in a prior study of CMHNs’ nursing philosophy …”

“…As described in the Results section, caregivers are able to authentically support consumers’ recovery when they are released from their own rigid ideas and as they confirm the meaning of living through self‐reflection over time. This phenomenon may be linked to a nursing philosophy theme from a previous work: “to have respect for consumers’ ways of life and their self‐realization.” Spirituality involves power . Thus, “high levels of spirituality” and “free spirits” may contribute to building communities in which residents support each other beyond their roles and act as driving forces to help support consumers in the community throughout Japan.…”

“…In response to these circumstances, psychiatric nurses who had become skeptical about the efficacy of the biomedically oriented and highly regimented care delivered in hospitals began opening independent psychiatric home‐visit nursing agencies to provide support as community mental health nurses (CMHNs) to persons living with mental illness in the community. CMHNs tend to be recovery‐oriented and help persons with mental illness discover their hopes and dreams so they can lead more meaningful lives, even if they have unresolved symptoms and disorders . Definitions of personal recovery have been introduced in many studies worldwide .…”

“…Given the many challenges of adopting this approach in Japan, we explored the experiential basis of this pioneering nursing philosophy. Previous research identified three themes associated with the adoption of a recovery model in the practice of these nurses: (i) having respect for consumers’ way of life and self‐realization; (ii) finding harmony between life and work; and (iii) building communities where residents support each other beyond their roles …”

“…CMHNs tend to be recovery-oriented and help persons with mental illness discover their hopes and dreams so they can lead more meaningful lives, even if they have unresolved symptoms and disorders. [3][4][5] Definitions of personal recovery have been introduced in many studies worldwide. 6 The following elements are key tenets of recovery-oriented practice: alleviation of stigma, a recovery-supportive perspective, recoverysupportive relationships, and multidisciplinary team approaches.…”