Abstract
Purpose: To discuss the most fundamental Japanese value, Wa (harmony), and its implications for nursing ethics in Japan. Background: Much has been written about the confusion of value orientations among Japanese nurses whose professional socialization is heavily influenced by Western culture and whose personal and clinical life depends on traditional Japanese culture. This literature also urges clarification of the values that constitute the deep structure of Japan's ethnic collective unconscious in order to clarify the differences between Western and Japanese cultures. Methods: The concept Wa was analyzed from a literature review. The authors' research data were then used to explore the Japanese nurses' perceptions of this concept as reflected in their everyday practice. Results & Discussion: The concept Wa, originating from Confucianism, means people working in harmony and politeness in a group, with full appreciation of the uniqueness of its members, to reach the goal: goodness, peace and growth of all the members involved. Confucianism emphasizes not to confuse Wa and Doh (conformity with superficial agreement). Doh means you conform and do not express ideas but just act like everyone else so as not to rock the boat. Some Japanese nurses confused Wa and Doh and replaced Wa with Doh in their work lives. In this meaning the slogan 'workplace harmony' threatened those nurses' professional decision making. Some other nurses used Wa in its original Confucian meaning in discussions with the physician whose order had been perceived by the nurse as harmful for the patient, or with the mother who had refused to tell the truth to her terminally ill daughter. The outcome was the patient's benefit while at the same time keeping peaceful and harmonious relationship among the people involved. Those nurses' characteristics included calmness, modesty, warmth, politeness and assertiveness. Their actions were better explained by the concept Wa rather than the Western notion of nursing advocacy where courage is emphasized as the virtue of the nurse. It is important to have a culturally clear definition of Wa and an understanding of how it can be used for teaching nursing ethics in Japan. The need for further research was suggested to clarify other values residing in the Japanese nurses' conduct.
