Public Health Nurses' Experiences in Caring for the Fukushima Community in the Wake of the 2011 Fukushima Nuclear Accident.

OBJECTIVE: This study described public health nurses' (PHNs) experiences in caring for people in their communities during the recovery stage of the Fukushima nuclear accident. DESIGN AND SAMPLE: Forty-four PHNs responded to an open-ended questionnaire administered before a radiation protection workshop and participated in interviews after the workshop. Data were qualitatively analyzed. RESULTS: Two major themes were identified: (1) profound powerlessness and (2) compelling sense of mission. The participants cared for people driven by their compelling sense of mission, despite not having the correct information or sufficient knowledge. They spoke of being heart-broken and barely able to face the reality of the impact of the accident. CONCLUSIONS: PHNs supported people because of a compelling sense of mission yet it was a great burden. Education about radiation and radiation protection for nursing students and PHNs, two-way communication between PHNs and radiation specialists, long-term support by specialists, and the opportunity for PHNs to share their feelings and experiences is necessary.

Ethical issues in practice: a survey of home-visiting nurses in Japan.

AIM: The purposes of this study were to identify specific components and frequencies of ethical issues that home-visiting nurses encountered in their practice, relationships between ethical issues and demographic data, and experience of ethics education and workplace environment. METHODS: A self-administered questionnaire was distributed to home-visiting nurses in Japan. Usable data (1961) were analyzed. RESULTS: Item and exploratory factor analysis for the frequency of encountering ethical issues revealed: (i) concern about respecting client or relationships with relevant professionals; (ii) differences in treatment or care-taking views among home-visiting nurse and client and family, or relevant professionals; and (iii) discrepancy of intention between family and client or home-visiting nurse. All factors were significantly positively related to the current position, duration of working experience as a home-visiting nurse, and type of nursing education; age was significantly negatively related. Home-visiting nurses noted that programmed continuing education systems and staff-training programs were not sufficiently available. CONCLUSION: The findings of this study indicated the characteristics of ethical issues that home-visiting nurses encountered in their practice and insufficient continuing education system including ethics education. Ethics education programs tailored to home-visiting nurses ethical concerns and traits and continuing education systems are needed.

Ethical issues in practice: a survey of public health nurses in Japan.

OBJECTIVES: The purposes of this study were to identify specific components and frequencies of ethical issues that public health nurses (PHNs) encountered in their practice, relationships between ethical issues and demographic data, and ethics education and workplace environment. DESIGN AND SAMPLE: Cross-sectional survey for PHNs at local governmental agencies in Japan. Usable data were 3,409. MEASURES: Public health nurses completed the frequency of ethical issues, experience of ethics education, workplace environment, and demographics. RESULTS: Item and exploratory factor analysis for the frequency of encountering ethical issues revealed: (1) discrepancy of intention between client and his/her family on treatment or care; (2) differences in views between PHNs and their organization's administrators regarding providing services; and (3) discrepancy of caretaking views between PHNs and various professionals. All factors were related to work experience and one factor was specifically related to the type of local government employing PHNs. Only 11.1% of PHNs received ethics education via continuing education programs. PHNs reported that programmed continuing education systems were not sufficiently available. CONCLUSIONS: Systematic continuing ethics education programs for PHNs need developing, tailored to the specific characteristics associated with PHNs' ethical concerns, such as nurses' working experience and the type of employing local government.

The Japanese value of harmony and nursing ethics.

Harmony is one of the most fundamental Japanese values. It is derived from Confucianism and encompasses a state of mind, an action process and outcomes of the action. This article draws on research data and discusses Japanese nurses' perceptions of harmony as reflected in their everyday practice. The most important virtues for these nurses were reported as politeness and respect for other persons. The outcome from the nurses' harmonious practice, it is claimed, benefited patients and created peaceful, harmonious relationships for all. Because of the unique link between harmony and the location of interaction, the ideal 'workplace harmony' threatened some nurses' professional decision making. These nurses confused harmony with conformity by superficial agreement. The Japanese seniority system could be a major factor contributing to this problem. Ethics education that includes traditional values and concepts in Japanese culture is strongly urged.

Whistleblowing in Japan.

This article, written from research data, focuses on the possible meaning of the data rather than on detailed statistical reporting. It defines whistleblowing as an act of the international nursing ethical ideal of advocacy, and places it in the larger context of professional responsibility. The experiences, actions, and ethical positions of 24 Japanese nurses regarding whistleblowing or reporting a colleague for wrongdoing provide the data. Of these respondents, similar in age, educational level and clinical experience, 10 had previously reported another nurse and 12 had reported a physician for a wrongful act. These data raise questions about overt actions to expose a colleague in a culture that values group loyalty and saving face. Additional research is needed for an in-depth understanding of whistleblowing, patient advocacy and professional responsibility across cultures, especially those that value group loyalty, saving face and similar concepts to the Japanese Ishin Denshin, where the value is on implicit understanding requiring indirect communication. Usually, being direct and openly discussing sensitive topics is not valued in Japan because such behavior disrupts the most fundamental value, harmony (wa).

Japanese patients' descriptions of "the good nurse": personal involvement and professionalism.

According to recent nursing literature, virtue ethics is regaining attention as a way to establish a comprehensive nursing ethical model, which will appropriately reflect actual nursing. This study explored the characteristics of "the good nurse" as an ethical ideal from Japanese patients' perspectives. The findings described the good nurse for Japanese nursing care recipients and delineated their expectations of her or him. For Japanese patients, the good nurse was a person with personal involvement and professional comportment. The study revealed the participants' perspectives of the importance of person-to-person relationships between nurses and patients, and of nurses' professional disposition and competency.

A pilot study of selected Japanese nurses' ideas on patient advocacy.

This pilot study had two purposes: (1) to review recent Japanese nursing literature nursing advocacy; and (2) to obtain data from nurses on advocacy. For the second purpose, 24 nurses at a nursing college in Japan responded to a questionnaire. The concept of advocacy, taken from the West, has become an ethical ideal for Japanese nurses but one that they do not always understand, or, if they do, they find it difficult to fulfil. They cite nursing leadership support as necessary to enacting this role. Discussion on meaning of and the rationale for advocacy in a society where goodness or badness is relative to social situations and its impact may reveal two parallel but overlapping views of morality. Such a situation would not only influence notions of advocacy but also possibly render them more complex.

A comparative study of Chinese, American and Japanese nurses' perceptions of ethical role responsibilities.

This article reports a survey of nurses in different cultural settings to reveal their perceptions of ethical role responsibilities relevant to nursing practice. Drawing on the Confucian theory of ethics, the first section attempts to understand nursing ethics in the context of multiple role relationships. The second section reports the administration of the Role Responsibilities Questionnaire (RRQ) to a sample of nurses in China (n = 413), the USA (n = 163), and Japan (n = 667). Multidimensional preference analysis revealed the patterns of rankings given by the nurses to the statements they considered as important ethical responsibilities. The Chinese nurses were more virtue based in their perception of ethical responsibilities, the American nurses were more principle based, and the Japanese nurses were more care based. The findings indicate that the RRQ is a sensitive instrument for outlining the embedded sociocultural factors that influence nurses' perceptions of ethical responsibilities in the realities of nursing practice. This study could be important in the fostering of partnerships in international nursing ethics.

Ethical issues after the disclosure of a terminal illness: Danish and Norwegian hospice nurses' reflections.

This research explored the ethical issues that nurses reported in the process of elaboration and further disclosure after an initial diagnosis of a terminal illness had been given. One hundred and six hospice nurses in Norway and Denmark completed a questionnaire containing 45 items of forced-choice and open-ended questions. This questionnaire was tested and used in three countries prior to this study; for this research it was tested on Danish and Norwegian nurses. All respondents supported the ethics of ongoing disclosure to terminally ill patients based on ethical principles embedded in their country's Patients' Rights Acts. Truth, as an intrinsic value, proved foundational to patient autonomy, the most frequent ethical principle these nurses reported to justify their ethical position on information disclosure to terminally ill people. Telling the truth about a diagnosis was not the end of ethics in hospice care, but rather the beginning because what occurs ethically in dealing with prognosis issues became central to these hospice nurses, the patients and their families. Coupled with truth-telling, compassionate interaction and care become extensions of patients' rights.

The ethics of withdrawing artificial food and fluid from terminally ill patients: an end-of-life dilemma for Japanese nurses and families.

End-of-life issues have become an urgent problem in Japan, where people are among the longest lived in the world and most of them die while connected to high-technology medical equipment. This study examines a sensitive end-of-life ethical issue that concerns patients, families and nurses: the withdrawal of artificial food and fluid from terminally ill patients. A sample of 160 Japanese nurses, who completed a questionnaire that included forced-choice and open-ended questions, supported this act under only two specific conditions: if the patient requested it, and if it relieved the patient's suffering. They considered that the doctor's orders, the family's request, or the patient's advanced age did not ethically justify this act. A small number of people who had recently lost a relative took part in semistructured interviews focusing on their experiences of their terminally ill relatives being given artificial food and fluid. Ethical, social and cultural factors surrounding this issue are discussed.

Questions of distributive justice: public health nurses' perceptions of long-term care insurance for elderly Japanese people.

This study examines public health nurses' perceptions and concerns about the implications of Japan's new long-term care insurance law concerning care provision for elderly people and their families. Respondents voiced their primary concern about this law as access to services for all elderly people needing care, and defined their major responsibility as strengthening health promotion and illness prevention programmes. Although wanting to expand their roles to meet the health care, social and public policy advocacy needs of elderly persons and their families, respondents also stated their concern for the possible lack of enough resources for this expansion to support family caregivers adequately. They viewed their first function as developing collaborative relationships with local government officials to help to assure sufficient resources to provide the necessary foundation for long-term care programmes to deliver services to all those in need. These concerns fall within the larger ethical issue of distributive justice in a society based on the obligations of the state to citizens and the family to its members, especially elderly relatives, who, according to traditional Japanese values, retain respect.