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Developing relationships: A strategy for compassionate nursing care of the dying in Japan

  • Kaori Shimoinaba (a1), Margaret O'Connor (a1), Susan Lee (a1) and David Kissane (a2)



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.


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.


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.

Significance of results:

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.


Corresponding author

Address correspondence and reprint requests to: Kaori Shimoinaba, School of Nursing and Midwifery, Monash University, Palliative Care Research Team, PO Box 527, Frankston VIC 3166Australia. E-mail:


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Athlin, E., Furaker, C., Jansson, L. & Norberg, A. (1993). Application of primary nursing within a team setting in the hospice care of cancer patients. Cancer Nursing, 16(5), 388397.
Davies, R.J. & Ikeno, O. (2002). The Japanese Mind: Understanding Contemporary Japanese Culture. Boston: Tuttle Publishing.
Donahue, R.T. (1998). Japanese Culture and Communication: Critical Cultural Analysis. Lanham: University Press of America.
Fredriksson, L. (1999). Modes of relating in a caring conversation: a research synthesis on presence, touch and listening. Journal of Advanced Nursing, 30(5), 11671176.
Graber, D.R. & Mitcham, M.D. (2004). Compassionate Clinicians: Take Patient Care Beyond the Ordinary. Holistic Nursing Practice, 18(2), 8794.
Hendry, J. (2003). Understanding Japanese Society. New York: RoutledgeCurzon.
Holloway, I. & Wheeler, S. (1996). Qualitative Research for Nurses. Oxford: Blackwell Science.
Hospice Palliative Care Japan (2010). Number of palliative care units and palliative care beds. Retrieved from
Hospice Palliative Care Japan. (2012). Number of palliative care units and palliative care beds in each prefecture. Retrieved from
Kashiwagi, T. (1999). The history and the fact of palliative care in Japan. Japanese Journal of Nursing, 51(3), 2428.
Le Vine, R.A. (2001). Preference: Japan as Front Line in the Cultural Psychology Wars. In Japanese Frames of Mind: Cultural Perspectives on Human Development, Shimizu, H. & Le Vine, R.A. (ed.), pp. xi–xxii. Cambridge: Cambridge University Press.
Lee, S., Kristjanson, L.J. & Williams, M. (2008). Professional relationships in palliative care decision making. Support Cancer Care, 17(4), 445450.
Liamputtong, P. & Ezzy, D. (2005). Qualitative Research Methods (2nd ed). South Melbourne: Oxford University Press.
Lobiondo-Wood, G. & Harber, J. (2006). Nursing Research: Methods and Critical Appraisal for Evidence-Based Practice. St. Louis: Mosby Elsevier.
Lopez, G.I., Figueroa, M., Connor, S.E. & Maliski, S.L. (2008). Translation Barriers in Conducting Qualitative Research With Spanish Speakers. Qualitative Heath Research, 18(12), 17291737.
Makino, S. (2002). Uchi and Soto as Cultural and Linguistic Metaphors. In Exploring Japaneseness On Japanese Enactments of Culture and Consciousness, Donahue, R.T. (ed.), pp. 2964. Westport: Ablex Publishing.
Markus, H.R. & Kitayama, S. (1991). Culture and the Self: Implications for Cognition, Emotion, and Motivation. Psychological Review, 98(2), 224253.
McQueen, A. (2000). Nurse-patient relationships and partnership in hospital care. Journal of Clinical Nursing, 9, 723731.
Mok, E. & Chiu, P.C. (2004). Nurse-patient relationships in palliative care. Journal of Advanced Nursing, 48(5), 475483.
Papadatou, D., Papazoglou, I., Bellali, T. & Petraki, D. (2002). Greek Nurse and Physician Grief as a Result of Caring for Children Dying of Cancer. Pediatric Nursing, 28(4), 345353.
Ritter-Teitel, J. (2002). The impact of Restructuring on Professional Nursing Practice. JONA, 32(1), 3141.
Shinmura, I. (1998). Kojien [Japanese Dictionary]. Tokyo: Iwanami-Shoten.
Shimoinaba, K., O'Connor, M. & Lee, S. (2010). Japanese head nurses’ perspectives regarding issues of nurses working in palliative care units and current support systems. Progress in Palliative Care, 18(6), 358363.
Smedley, G.R. (1998). Assessing primary nursing in mental health. Nursing Standard, 12(21), 3538.
Stein-Parbury, J. (2005). Patient and person: Interpersonal skills in nursing. Sydney: Elsevier.
Strauss, A. & Corbin, J. (1998). Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. Thousand Oaks: Sage Publications.
Taylor, B., Kermode, S. & Roberts, K. (2006). Research in Nursing and Health Care: Evidence for Practice (3rd ed.). South Melbourne: Thomson.
Vachon, M.L.S. (1995). Staff stress in hospice/palliative care: a review. Palliative Medicine, 9, 91122.
Webb, C. & Pontin, D. (1996). Introducing primary nursing: nurses' opinions. Journal of Clinical Nursing, 5, 351358.
Weissman, J. & Appleton, C. (1995). The Therapeutic Aspects of Acceptance. Perspectives in Psychiatric Care, 31(1), 1923.
Williams, A. (2001). A literature review on the concept of intimacy in nursing. Journal of Advanced Nursing, 33(5), 660667.


Developing relationships: A strategy for compassionate nursing care of the dying in Japan

  • Kaori Shimoinaba (a1), Margaret O'Connor (a1), Susan Lee (a1) and David Kissane (a2)


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