Comparison of Nursing and Peer Support Worker Support in Crisis Plans for People with Mental Disorders in Japan: A Pilot Study Using Modified Grounded Theory Approach Within a Realist Evaluation Framework

This pilot exploratory qualitative study used the Modified Grounded Theory Approach (M-GTA) and the Realist Evaluation (RE) framework to clarify the interrelationships between nursing support and Peer Support (PS) in the creation and utilization of Crisis Plans (CPs) in Japan. Findings revealed that nursing support, constrained by psychiatric ward institutions, struggled with internal conflict while seeking to bridge risk and recovery. In contrast, PS support, rooted in lived experience, reframes crisis and risk, actively fostering patient self-determination and growth, and transforming. We propose an exploratory Context–Mechanism–Outcome (CMO) model that maps the distinctive contributions and interactions of nursing and PS support. This model provides provisional insights to inform the development of more robust, recovery-oriented CP support systems.