Virtue ethics and principle-based ethics are two major approaches in nursing and healthcare ethics. These approaches complement each other by emphasizing different aspects of ethics. Principle-based ethics emphasizes action, and virtue ethics focuses on character and attitudes of the person who performs the action. Virtue ethics, almost pushed aside the dominance of principle-based ethics since the 1970s, is regaining attention in the recent international literature. Whereas the nursing literature in Japan reports that virtue ethics is rarely included in the ethics course topics which center around medical issues and principle-based ethics. Perhaps this is because the memory of old virtues, that undermined nursing's professional development, still lingers in Japanese nursing. This article sheds a new light on virtue ethics and discusses its importance for nursing in Japan. The authors' research findings are used in the discussion to suggest the following: 1) It is important to explore nursing's evolving virtues to meet the society's expectations of nurses, 2) Practice contexts and nurses' narratives are good materials for teaching and learning virtue ethics in class as well as in practice, 3) Culturally, virtue ethics fits with nurses better than principle based ethics, and 4)Dialogues is essential to the teaching of nursing ethics.

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The Time Trade-Off (TTO) Method is one of the generic instruments in the measurement of HRQOL. When diabetic outpatients are divided into 2 groups by the TTO method, evaluation of HRQOL in diabetic outpatients who would wish to trade their remaining life with disease (diabetic state) for a shorter life without disease (Trade-off Group) is lower than that of the patients would not wish to trade (Non Trade-off Group).
Aims: These aims are to investigate which factors are significantly associated with the high probability of increasing the number of diabetic outpatients that composes Trade-off Group.
Methods: One hundred and ninety seven diabetic outpatients participated in this study after they signed the informed consent form. The questionnaire and the TTO method were used.
Results: 1) On results of the TTO method, Trade-off Group was composed of 42 patients (37.5%), Non-Trade-off Group was composed of 47 patients (62.5%). 2) On diabetes and the treatment have an negative effect on daily life of diabetic outpatients; The principal-component factor analysis with Varimax rotation was applied to date of 112 patients for 14 items, and 4 factors were separated out. 4 factors were named: loneliness factor from restricted social activities (factor 1), getting worse factor (factor 2), hopeless future factor from physical and psychological troubles in daily life with diabetes (factor 3), and negative feelings factor from severe diet control (factor 4). 3) Results of Logistic regression analysis; Getting worse, having negative feelings from severe diet control and physical symptoms were significantly associated with the high probability of increasing the number of diabetic outpatients that composes Trade-off Group.
Conclusions: These results clearly show the necessity to provide more supportive care in their physical and psychological fields for Trade-off Group. The next problem would be to investigate the relation between these 3 factors (getting worse, having negative feelings from severe diet control and physical symptoms) and Non-Trade-off Group.

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Purpose: A comprehensive cardiac rehabilitation program was designed in order to modify lifestyle and to remove coronary risk factors through acquisition of self-management skills. The purpose of this study was to examine the efficacy of the program.
Method: The program was implemented to 46 outpatients with ischemic heart disease at two hospitals. A nonrandomized, before-after trial was conducted on the program, where the patients were met by a nurse and a registered dietitian once a month for 30 minutes and were monitored monthly via a telephone.
Results: Seven subjects dropped out from the program after the first session while the remaining 39 completed the program (the completion rate: 84.8%), resulting in an improvement of all the indicators. Statistically significant improvements were observed in the following areas: The weight, abdominal circumference, HbA_1c, dietary and exercise goal achievement rates, QOL, and sense of self-efficacy. The numbers of subjects showing Type A and depression were decreased. Relationships among an improvement in achievement rate, the sense of self-efficacy, and a betterment in the behavioral stage were observed.
Conclusion: The results showed that the acquisition of self-management skills led to rectifying coronary risk factors and an improvement of QOL. The efficacy of the present program was thus confirmed.

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Objectives: This study was designed to clarify the process that familial adenomatous polyposis patients go through, from recognizing the genetic risks faced by their children to disclosing genetic information to their children.
Methods: The study involved semi-structured interviews with eight familial adenomatous polyposis patients and qualitative analysis of the collected interview data.
Results: As a result of the analysis, the following three categories were extracted with respect to the process experienced by study participants before disclosing genetic information to their children: 1) Past experience that might have influenced participants' disclosure of genetic information to their children; 2) Preparations participants made before communicating genetic information to their children; and 3) Factors that influenced participants to make up their minds to communicate genetic information to their children. Regarding how to communicate genetic information, some participants communicated genetic risks, and others communicated genetic information based on the results of genetic tests. Regarding the decision about having their children undergo genetic testing as a presymptomatic test, participants made decisions depending on whether their children were old enough to be able to express their own wishes.
Conclusion: The study results suggest that nurses should not force their professional values or place too much importance on providing information regarding genetic testing, from the standpoint of preventing family members from contracting cancer. Instead, nurses involved in genetic medicine should first try to solve problems being faced by patients, in the process prior to disclosing genetic information to their children.

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This study is intended to clarify relationships of characteristics, beliefs, and self-care in patients receiving dialysis. To determine the beliefs and self-care of 228 patients, they were assessed using a questionnaire, the Japanese Health Locus of Control (JHLC) scale, and the Japanese Irrational Belief Test (JIBT), and an original self-care scale, which has two subscales, “Life” and “Diet”. Associations among characteristics, beliefs, and self-care were examined using Pearson's correlation and Student's t-test. Consequently, regarding the self-care score, the item related to dosing was the highest; the item related to appropriate exercise was the lowest. Significant correlation (p<0.05) was also found: “Life” of self-care and “Family”, “Chance”, and “Professional” of JHLC, which are equivalent for external HLC were correlated. However, “Diet” of self-care was unrelated to JHLC and JIBT. Heretofore, the beliefs of dialysis patients and relationships with self-care have tended to be told anecdotally. Results of this quantitative study suggest that, in cases where patients cannot do “Life” of self-care well, contact with families and their encouragement by professionals is considered valuable.

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One purpose of this study was to examine how the relationship between caregivers and the elderly care receivers is associated with the position of caregivers and the direction of their eyes toward the elderly. The other purpose was to assess the usability of the inter-personal distance evaluation form. We examined 53 primary caregivers, which were classified into two groups: 27 of them who abused the elderly, and 26 who didn't. We also adopted the inter-personal distance evaluation form which projects psychological distance of caregivers toward the elderly who receive their care.
The result shows that in the situations set on the evaluation form, “caregiver stickers” were mostly affixed to the side or diagonally behind the elderly. However more than half of the abusive caregivers were situated outside the room or directly behind the elderly when they wandered or needed help with eating. Such positions are observed when caregivers disassociate themselves from the elderly. As for the direction of their eyes, caregivers mostly watched the elderly in front or within their views, yet in the case of the abusive caregivers, they cast their eyes to irrelevant directions when the elderly were wandering (77.7%) or being rebellious (70.3%). These results imply that the inter-personal distance evaluation form which describes the position of caregivers and the direction of their eyes reflects the relationship between caregivers and the elderly care receivers.

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The purpose of the study was to describe how the patients who suffered from post apoplectic numbness experienced their daily lives and also the meanings of those experiences. The study conducted unstructured interviews and analyzed all data by qualitative methods. After the analyzed, the following results were found.
Because of the numbness, the movements were uncertain; the understanding of the living space that performed unconsciously became difficult, too. If this daily lives continued, there was a potential that the self-support foundation and the patients self-esteem might be unstable. Also, the following results were particularly recognized: the patients were stressed because of the numbness and their decreasing body-control whenever they attempted to move their muscles for ordinary actions, which reminded them of their disorder. This can be said that, for the patients, this was the manifestation of the phantasmagoric of the numbness. Moreover, the notable point is, after they repeatedly adapted their new movement and found improvement;they will become “familiar” with the new movement. By this process, even if they were not completely recovered from their numbness, the patients could gradually reduce their stresses.

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