title: Japanese care workers' perception of dementia-related physically and psychologically aggressive behaviour symptoms.
abstract: OBJECTIVE
  The purpose of this study was to explore Japanese care workers' attributions, beliefs and cultural explanations of physically and psychologically aggressive behaviour symptoms.
  
  
  BACKGROUND
  Physically and psychologically aggressive behaviour symptoms by older people with dementia have been associated with occupational stress among care workers in the United States and other Western countries and may contribute to staff turnover. However, few studies related to this issue have been conducted in Japan, where care worker reaction to physically and psychologically aggressive behaviour symptoms might be different because of cultural and customary differences in how care is provided for older people.
  
  
  METHODS
  This study reports on the results of three open-ended questions that were part of a larger study that explored Japanese care workers' experiences with aggressive behaviour symptoms in persons with dementia. Convenience sampling was used to recruit 137 care workers in 10 nursing homes in the northern and western areas of Japan. The answers to the open-ended questions were analysed using a content analysis.
  
  
  RESULTS
  Most of the participants indicated that they believed that physically and psychologically aggressive behaviour symptoms came from residents' stress from dementia. Approximately, one-fourth of the participants responded that Japanese values such as chu (loyalty) and joge (hierarchy) influenced their work with residents with physically and psychologically aggressive behaviour symptoms. Seventeen participants (12%) commented either that they respected older people or that they respected older people as persons who had had many experiences in life. Interestingly, 43 responses (41.0%) indicated that physically and psychologically aggressive behaviour symptoms influenced quality of care positively, while, not surprisingly, about 30 responses indicated that those behaviour symptoms influenced quality of care negatively.
  
  
  CONCLUSIONS
  Findings from this study indicate that the training and education needs to focus on understand and preventing the effects of stress for individuals living with dementia to reduce aggressive incidents and increase recruitment and retention of care workers.
authors.affiliation: School of Nursing, University of Shiga Prefecture, Hikone, Shiga, Japan.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Hirata
authors.affiliation: Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, USA.
authors.forename: Theresa A
authors.initials: TA
authors.lastname: Harvath
mesh_terms: D000328:Adult; D000368:Aged; D000374:Aggression; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D003704:Dementia / Q000451:nursing* / Q000523:psychology*; D005260:Female; D006801:Humans; D016901:Intergenerational Relations; D007564:Japan; D008297:Male; D008875:Middle Aged; D009723:Nurse-Patient Relations; D009735:Nursing Homes; D009740:Nursing Staff; D011787:Quality of Health Care; D011795:Surveys and Questionnaires
keywords: Japanese values; aggressive behaviour symptoms; care worker; dementia; perception