To understand the change in nurses’ focus related to the practice of urinary incontinence care before and after participating in a workshop using SSM (Soft Systems Methodology) [1] for learning reinforced emotional reflection.

The workshop, composed of five stages on urinary incontinence care including discussion about nurses’ expertise in urinary incontinence care, anatomy of lower urinary tract, assessment and care of urinary incontinence, teaching methods for pelvic floor muscle exercises, caring, communication, case studies, and implementation of 7 stages using SSM such as expressing the image of urinary incontinence care in painting for strengthening reflection on the emotional aspect, was held across two months for 27 nurses with an experience of 2 or 3 years in three institutions; before and after the workshop, the nurses were interviewed for 30 minutes to understand their reflections related to urinary incontinence care, which were transcribed verbatim. A text-mining approach [2] was employed using 2,836 sentences, 1,961 types of words, and a total of 18,387 words. Comparisons before and after the workshop were made using correspondence analysis and co-occurrence networks. These analyzes are conducted using the frequency of occurrence. In this study, the frequency of occurrence was set to 60 times or more.

The results of correspondence analysis before and after learning are shown in Figure 1. Uncategorized words are shown above and below at point 0 of dimension 1; these comprised frequently occurring words such as  “patient,” “little,” “time,” “urinary,” that were similar for both before and after. The words used before and after learning are arranged at the right and left points of dimension 1 as per their occurrence; for instance, before learning, words such as “senior,” “possible,” and, “ward” were used, while after learning, words such as “learn,” “think,” and “become” were used. The result of co-occurrence network is shown in Figure 2. The larger the circle, the higher was the frequency of occurrence, and the thicker the dotted line, the stronger was the co-occurrence.The numbers in the brackets are Jaccard indices, which represent the degree of co-occurrence. Not considering the period before or after learning, “patient” (Jaccard index .187) appeared with a frequency of 594. Before learning, the words “do” (. 151), “do not” (. 099), “when” (. 099), “go” (. 078), and after learning, the words “think” (. 196), “time” (. 101), “well” (. 082), “something” (. 080), “what” (. 068), and “feel” (. 043) demonstrated co-occurrence.

Regardless of the presence or absence of learning, the focus of nurses was devoted to the “patient.” Changes in focus before and after learning were based on whether a “do” and “do not” organizational culture in “ward” and “senior” were “possible.” After learning, as a result of “learn” and “thinking,” the nurses came to focus on “something,” which was “become.” It was observed that the learning led to opposing “ward” and “senior.” This result indicated the need examine the organizational culture of the ward in order to establish better urinary incontinence care. Moreover, before learning, the focus was on “when” to “change” “diapers,” but after learning, the focus shifted to a more positive emotional aspect like “good,” “well,” and “feel.” The nurses’ mental state during urinary incontinence care greatly affects the physical and mental condition of the patient. In addition to be able to reflect on nurses focusing on their own emotions is extremely useful in analyzing patients and situations [3]. SSM comprises the function to promote control of the mind by enabling nurses to easily express their negative feelings.

The urinary incontinence care workshop using SSM may have changed nurses’ focus to increased thinking and considering of emotional aspects. I would like to thank Editage (www.editage.jp) for their English language editing.

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