Figure 5. Bubble plot of latent factors in suffering perceived by patients in a stable condition.

Figure 6. Co-occurrence network of latent factors in suffering perceived by patients in a stable condition.

Figure 7. Hierarchical cluster of Japanese patients’ expectations of nurses when suffering in a stable condition.

Figure 8. Bubble plot of Japanese patients’ expectations of nurses when suffering in a stable condition.

Figure 9. Co-occurrence network of Japanese patients’ expectations of nurses when suffering in a stable condition.

regarding this.”

As an interpretation of this, the patient is preparing for the next scheduled discharge time. However, the nurse does not infer the patient’s irritated affect and he/she provides no response (explanation). The nurse is busy performing care for other patients and recognizes that other patients are a priority. Therefore, the patient suffers while waiting patiently without declaring his/her thoughts of the irritation. The patient’s irritation becomes the focus. Affect is a generic name indicating various feelings aperson experiences; it is closely related to emotion and mood [28] and clearly indicates how a person feels [29] . Although the patient is irritated (affect), he/she cannot clearly and logically convey this to the nurse. In other words, when a situation cannot be understood objectively, the affect of the involved parties increases. Affect is subjective, and it has been suggested that it is impossible to adequately convey the properties of affect in language [30] .

4.1.2. Timing Problems

Original text case: “The nurse did not notice that a nurse call was made from the toilet and the patient was left waiting in the toilet for quite a long time. There was no apology for this that satisfied the patient.”

As an interpretation of this, the patient’s experience of being kept waiting in the toilet caused fear. However, it was a busy period for the nurse and the nurse recognized that the response was slightly delayed. Consequently, there is a gap between the nurse and patient regarding time. When the patient perceives and inappropriate gap, he/she feels suffering. There is an existing gap between nurses who are actively busy throughout the day and patients whose activity level is decreasing due to treatment; this also influences how events are understood. When taking an action-research approach, the process of learning through living experience includes the potential to reduce the gap between theory and practice [31] [32] [33] . By having a real sensation by entering the lives of others, one can move toward a solution. However, it is suggested that if it is impractical to enter a patient’s life, nurses must use their imagination.

4.2. Latent Factors in Suffering

4.2.1. Privacy Issues

Original text case: “I cannot leave my bed and when I mentioned that there was something I wanted to consult with the nurse about, the nurse said in a voice loud enough for the other patients and visitors in the room to hear: ‘What’s the matter? Please go ahead and tell me, whatever it is.’ The nurse didn’t consider that I wanted to speak privately.”

As an interpretation of this, although the patient was asked by the nurse, it was without consideration, and the patient endured feeling discomfort.

4.2.2. Nurses’ Not Intervening on Patients’ Behalf

Original text case: “In situations where my physical strength is extremely depleted, such as fever, etc., voices of other visitors in the same room are very noisy. I want the nurse to notice this and warn them (on my behalf).”

Although the patient’s condition was stable, he/she had a fever. Therefore, he/she is very uncomfortable when it is too noisy. In this case, the patient was concerned that if he/she warns the visitors, it will harm his/her relationship with the other patients in the room; therefore, he/she would like the nurse, who is neutral, to warn them. The patient recognizes that these warnings are the nurse’s responsibility. If this is not enacted, it becomes a latent factor in the patient’s suffering.

Therefore, this factor is related to affect control such as suppression; concentration; and retention of a condition, urge, or emotion [34] . Although affect control is a socially necessary skill, it is thought to lead to suffering if its exceeds the patient’s personal range of control. Suffering is a personal perception or experience; since humans perceive the experience of suffering in unique ways [35] , it may be difficult for another person (in this case the nurse) to notice. Therefore, a “lack of the nurse’s awareness” became a latent factor in the patient’s perceived suffering.

4.3. Japanese Patients’ Expectations of Nurses

Since no particularly strong relationships were shown, it is believed that patients’ expectations are thought to be very diverse and without patterns. For patients to receive high-quality care, it is extremely important for nurses to understand patient suffering [36] and Millar [37] points out that communication is a core element of this. In other words, a nurse is required to sense the patients’ expectations from communication one who is unable to do so is thought to cause patient suffering. In contrast, it is also necessary to determine patients’ feelings through their non-verbal communication.

4.4. Cultural Factors

In Japan, individuals are taught to coexist and not harm others. They are also taught to avoid expressing affect such as personal thoughts and emotions. Expressing one’s thoughts and emotions indirectly rather than directly is an art and uses a variety of expressive methods. Consequently, there is an expectation that one wants to and wants other to infer truth. That is, words such as “attentiveness” and “concern” that express Japanese spirit [38] are at the foundation and the space between people that creates a positive atmosphere (in Japanese, awai) is a characteristic of Japanese communication. However, the existing problem is that Japanese nurses are following Western teaching and communication. These cultural factors are not applicable to Japanese patients, and nurses are not perceiving their suffering effectively.

4.5. Clinical Contributions

Patients’ in stable conditions have their thoughts easily overlooked. However, by understanding the characteristics of patients’ perceived suffering and using basic communication skills, the nurse-patient relationships can be improved and high-quality nursing care can be provided. Communication that reaffirms diverse cultural backgrounds is necessary.

4.6. Study Limitations and Future Prospects

Rather than separately examining the perceptions of nurses or patients, it is necessary to concurrently verify conflicts and other situations that arise between nurses and patients and to conceptualize both nurses’ and patients’ perception of suffering.

5. Conclusion

Features of suffering perceived by Japanese patients in a stable condition included factors such as “lack of inference,” “privacy issues,” and “nurses’ not intervening on patients’ behalf.” These were shown through a text analysis, which suggested that emotion has a complicated influence. Moreover, the Japanese culture of expression influences patients’ suffering; however, it seems that Japanese nurses tend to forget this.


We extended our heartfelt appreciation to all those who kindly assisted with this study. There are no conflicts of interest to declare.

Cite this paper
Uno, M. , Tsujimoto, T. and Inoue, T. (2017) Features of Suffering Perceived by Japanese Patients in a Stable Condition: A Text Analysis. Open Journal of Nursing, 7, 1021-1033. doi: 10.4236/ojn.2017.79074.
[1]   Otani, K. and Kurz, R.S. (2004) The Impact of Nursing Care and Other Healthcare Attributes on Hospitalized Patient Satisfaction and Behavioural Intentions. Journal of Healthcare Management, 49, 181-196.

[2]   Sharma, S.K. and Kamra, P.K. (2013) Patient Satisfaction with Nursing Care in Public and Private Hospitals. Nursing and Midwifery Research Journal, 9, 130-141.

[3]   Ellis-Jacobs, K.A. (2011) A Quantitative Correlational Study on the Impact of Patient Satisfaction on a Rural Hospital. The Internet Journal of Allied Health Sciences and Practice, 9. http://ijahsp.nova.edu/articles/Vol9Num4/pdf/ellis-jacobs.pdf

[4]   Lee, M.A. and Yom, Y.H. (2007) A Comparative Study of Patients’ and Nurses’ Perceptions of the Quality of Nursing Services, Satisfaction and Intent to Revisit the Hospital: A Questionnaire Survey. International Journal of Nursing Studies, 44, 545-555.

[5]   Shirley, E.D. and Sanders, J.O. (2013) Patient Satisfaction: Implications and Predictors of Success. The Journal of Bone and Joint Surgery. American Volume, 95, e69-1-4.

[6]   Ting, C.Y. and Yu, T.K. (2010) Modeling Patient Perceptions of Service Recovery: The Effects of Perceived Fairness on Health Center Repatronage. Social Behavior and Personality, 38, 395-403.

[7]   Dzomeku, V.M., Ba-Etilayoo, A., Perekuu, T. and Mantey, R.E. (2013) In-Patient Satisfaction with Nursing Care: A Case Study at Kwame Nkrumah University of Science and Technology Hospital. International Journal of Medical Research and Health Sciences, 2, 19-24.

[8]   Donabedian, A. (1992) The Role of Outcomes in Quality Assessment and Assurance. QRB—Quality Review Bulletin, 11, 356-360.

[9]   Nelson, E.C., Mohr, J.J., Batalden, P.B. and Plume, S.K. (1996) Improving Health Care, Part 1: The Clinical Value Compass. The Joint Commission Journal on Quality Improvement, 22, 243-258.

[10]   Irvine, D., Sidani, S. and Mc Gillis, L.H. (1998) Linking Outcomes to Nurses’ Roles in Health Care. Nursing Economic, 2, 58-64.

[11]   Duffy, J.R. and Hoskins, L.M. (2003) The Quality-Caring Model. Advances in Nursing Science, 26, 77-78.

[12]   Korniewicz, D.M. and Duffy, J. (2008) Essential Concepts for Staff Nurses: The Outcomes Imperative. American Nurses Association, Continuing Education.

[13]   Mark, B., Salyer, J. and Wan, T.T.H. (2003) Professional Nursing Practice: Impact on Organizational and Patient Outcomes. Journal of Nursing Administration, 22, 224-234.

[14]   Yen, M. (2004) A Model for Testing the Relationship of Nursing Care and Patient Outcomes. Nursing Economic, 22, 75-80.

[15]   Tzeng, H.M. and Yin, C.Y. (2008) Patient Satisfaction versus Quality. Nursing Ethics, 15, 121-124.

[16]   Greiner, A.C. and Knebel, E. (2004) Health Professions Education: A Bridge to Quality. Journal for Healthcare Quality, 26, 54.

[17]   Institute of Medicine, Committee on Quality of Health Care in America (2001) Crossing the Quality Chasm: A New Health System for the 21st Century. Executive Summary.

[18]   World Health Organization (2008) Communication during Patient Handovers. Patient Safe Solutions, 1, 1-4.

[19]   Peterson, S.J. (2009) Interpersonal Relations. In: Peterson, S.J. and Bredow, T.S., Eds., Middle Range Theories: Application to Nursing Research, Lippincott Williams & Wilkins, Philadelphia, 202-230.

[20]   Peplau, H.E. (1991) Interpersonal Relations in Nursing: A Conceptual Frame of Reference for Psychodynamic Nursing. Springer, New York.

[21]   Bissell, P., May, C.R. and Noyce, P.R. (2004) From Compliance to Concordance: Barriers to Accomplishing a Re-Framed Model of Health Care Interactions. Social Science & Medicine, 58, 851-862.

[22]   Robbins, S.P. (2009) Essentials of Organizational Behavior. 8th Edition, Pearson Education, Inc., Prentice Hall, Diamond. (In Japanese)

[23]   Uno, M., Tsujimoto, T. and Inoue, T. (2014) Effect of Conflicts in Patient-Nurse Relations. Nursing Journal Osaka University, 20, 47-53. (In Japanese)

[24]   Uno, M. (2015) A Study Using SERVQUAL to Evaluate Trends in Patient Expectations when Conflict Arises. Journal of Yamato University, 1, 173-179.

[25]   Uno, M., Ikuta, S. and Okamoto, M. (2016) Aspects of Avoidance of Conflict between Nurses and Patients, According to Gold Nurses (or Expert Nurses): A Program for Raising the Quality of Nursing. Journal of Yamato University, 2, 91-97.

[26]   Uno, M., Tsujimoto, T. and Inoue, T. (2017) Perceptions of Nurses in Japan toward Their Patients’ Expectations of Care: A Qualitative Study. International Journal of Nursing Sciences, 4, 58-62.

[27]   Yamaguchi, I. (2011) Anna Nurse, Konna Nurse. Clinical Study, 19-30. (In Japanese)

[28]   George, J.M. (1991) State or Trait: Effects of Positive Mood on Prosocial Behaviors at Work. Journal of Applied Psychology, 76, 299-307.

[29]   Langer, S. (1964) Philosophical Sketches. The New American Library of World Literature, New York.

[30]   Rogers, M.E. (1970) An Introduction to the Theoretical Basis of Nursing. Nursing Research, 19, 541.

[31]   Webb, C. (1989) Action Research: Philosophy, Methods and Personal Experiences. Journal of Advanced Nursing, 25, 485-491.

[32]   Titchen, A. and Binnie, A. (1994) Action Research: A Strategy for Theory Generation and Testing. International Journal of Nursing Studies, 31, 1-12.

[33]   Simmons, S. (1995) From Paradigm to Method in Interpretive Action Research. Journal of Advanced Nursing, 21, 837-844.

[34]   Wegner, D.M. (1994) Ironic Process of Mental Control. Psychological Review, 101, 34-52.

[35]   Travelbee, J. (1971) Interpersonal Aspects of Nursing. Nursing Management, 1, 44.

[36]   Bégat, I.B. and Severinsson, E.I. (2001) Nurses’ Reflections on Episodes Occurring during Their Provision of Care—An Interview Study. International Journal of Nursing Studies, 38, 71-77.

[37]   Millar, B., Maggs, C., Warner, V. and Whale, Z. (1996) Creating Consensus about Nursing Outcomes. II. Nursing Outcomes as Agreed by Patients, Nurses and Other Professionals. Journal of Clinical Nursing, 5, 263-267.

[38]   Haga, Y. (2013) Nihonjin-rasisa-no-hakken. Taisyukansyoten, Tokyo. (In Japanese)