title: Developing relationships: A strategy for compassionate nursing care of the dying in Japan.
abstract: OBJECTIVE
  The aim of this study was to explore the type of relationship and the process of developing these relationships between nurses and patients in palliative care units in Japan. The special contribution that culture makes was examined to better understand the intensity of nurses' grief after the death of their patient.
  
  
  METHODS
  Thirteen Japanese registered nurses currently practicing in palliative care units were interviewed between July 2006 to June 2009. Theoretical sampling was utilised and the data were analysed using grounded theory methodology. Constant comparison was undertaken during coding processes until data saturation was achieved.
  
  
  RESULTS
  Significant cultural influences emerged both in the type of relationship nurses formed with patients and in the way they developed relationships. The type of relationship was termed 'human-to-human', meaning truly interpersonal. The cultural values of 'Uchi (inside) and Soto (outside)' have particular implications for the relationship. Four actions Being open, Trying to understand, Devoting time and energy, and Applying a primary nurse role, were identified as strategies for nurses to develop such relationships. The quality of this deeply committed encounter with patients caused nurses to grieve following patients' death.
  
  
  CONCLUSIONS
  Culture is a major influence upon the reasons, complexities, and impact that lie behind nurses' behaviours. Attention is needed to support nurses to sustain a fundamental caring quality in their relationships with patients.
authors.affiliation: School of Nursing and Midwifery,Monash University,Palliative Care Research Team, Frankston VICAustralia.
authors.forename: Kaori
authors.initials: K
authors.lastname: Shimoinaba
authors.affiliation: School of Nursing and Midwifery,Monash University,Palliative Care Research Team, Frankston VICAustralia.
authors.forename: Margaret
authors.initials: M
authors.lastname: O'Connor
authors.affiliation: School of Nursing and Midwifery,Monash University,Palliative Care Research Team, Frankston VICAustralia.
authors.forename: Susan
authors.initials: S
authors.lastname: Lee
authors.affiliation: Discipline of Psychiatry, School of Psychology and Psychiatry, Faculty of Medicine, Nursing and Health Sciences,Monash University,Frankston VIC,Australia.
authors.forename: David
authors.initials: D
authors.lastname: Kissane
mesh_terms: D000328:Adult; D004645:Empathy; D005260:Female; D006801:Humans; D007407:Interviews as Topic / Q000706:statistics & numerical data; D007564:Japan; D008875:Middle Aged; D009723:Nurse-Patient Relations; D009732:Nursing Care / Q000379:methods* / Q000592:standards; D010166:Palliative Care / Q000379:methods*; D036301:Qualitative Research
keywords: culture; grief; nursing; palliative care; relationship