A Japanese court on Monday sentenced a former assistant nurse to three years and eight months in prison for manually pulling 49 fingernails and toenails off of six female patients in 2004, Japanese media reported.

The Kyoto District Court ruled that Akemi Sato (32) committed cruel and selfish crimes against her patients, most of whom had almost no physical strength to resist. The victims, aged between 31 and 83, were bedridden and immobilized from strokes.

Sato, who worked at a Kyoto hospital, claimed she tried to release extreme stress she was suffering from a heavy workload and from other related issues by tearing nails off of her victims between September and October 2004, according to the Kyoto District Court ruling.

Though the defense lawyers appealed that Sato suffered from slight mental illness, the court ruled that the defendant was fully capable of judging right from wrong.

Sato pretended to be the first one to find the abuse committed against patients, thinking that no other hospital staff had witnessed her crime against the patients.