title: Patient advocacy: Japanese psychiatric nurses recognizing necessity for intervention.
abstract: BACKGROUND
  Advocacy is an important role of psychiatric nurses because their patients are ethically, socially, and legally vulnerable. This study of Japanese expert psychiatric nurses' judgments of interventions for patient advocacy will show effective strategies for ethical nursing practice and their relationship with Japanese culture.
  
  
  OBJECTIVE
  This article explores Japanese psychiatric nurses' decision to intervene as a patient advocate and examine their ethical, cultural, and social implications.
  
  
  METHODS
  Using semi-structured interviews verbatim, themes of the problems that required interventions were inductively summarized by a qualitative analysis and their contexts and nursing judgments were examined.
  
  
  METHODS
  The participants were 21 nurses with 5 or more years of experience in psychiatric nursing.
  
  
  METHODS
  The research was approved by Institutional Review Board of research site and study facilities. The participants gave written informed consent.
  
  
  RESULTS
  Analysis of 45 cases showed that nurses decided to intervene when (a) surrounding people's opinions impeded patients' safety, (b) healthcare professionals' policies impeded patients' decision-making, (c) own violent behaviors impeded treatment and welfare services for patients, (d) own or families' low acceptance of illness impeded patients' self-actualization, (e) inappropriate treatment or care impeded patients' liberty, and (f) their families abused patients' property.
  
  
  CONCLUSIONS
  To solve conflicts between patients and their surrounding people, the nurses sought reconciliation between them, which is in accordance with Japanese cultural norms respecting harmony. When necessary, however, they protected patients' rights against cultural norms. Therefore, their judgments cannot be explained by cultural norms alone.
  
  
  CONCLUSIONS
  The findings indicate that the nurses' judgments were based on respect for patients' rights apart from cultural norms, and they first sought solutions fitting the cultural norms before other solutions. This seems to be an ethical, effective strategy if advocates know the culture in depth.
authors.affiliation: Japanese Red Cross Hiroshima College of Nursing, Japan yt11147@jrchcn.ac.jp.
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Toda
authors.affiliation: Kochi University, Japan.
authors.forename: Masayo
authors.initials: M
authors.lastname: Sakamoto
authors.affiliation: Nagano College of Nursing, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Tagaya
authors.affiliation: Kochi University, Japan.
authors.forename: Mimi
authors.initials: M
authors.lastname: Takahashi
authors.affiliation: Nagano College of Nursing, Japan; University of California at San Francisco, USA.
authors.forename: Anne J
authors.initials: AJ
authors.lastname: Davis
mesh_terms: D000328:Adult; D003466:Cultural Characteristics; D004993:Ethics, Nursing; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D001523:Mental Disorders / Q000451:nursing*; D008875:Middle Aged; D009723:Nurse-Patient Relations; D010344:Patient Advocacy / Q000941:ethics* / Q000523:psychology*; D028701:Patient Rights / Q000941:ethics; D011568:Psychiatric Nursing; D036301:Qualitative Research; D066262:Social Norms
keywords: Expert nurse; mental disorders; nursing judgment; patient advocacy; patient’s right; psychiatric nursing