This study aims to reduce nurses’ stress responses caused by moral distress by verifying a causal model based on the hypothesis that the moral distress faced by nurses is directly and indirectly associated with their emotional exhaustion via coping.

  The subjects of analysis were 927 nurses working at hospitals. The survey was conducted via a self-administered, anonymous questionnaire. The survey items were basic attributes, moral distress, coping, and emotional exhaustion. Confirmatory factor analysis was performed to assess the fit of the data to the hypothesized causal model. The analysis results showed that the hypothesized causal model fit the data well. A significant positive relationship was observed between moral distress and emotional exhaustion. Emotional exhaustion also had a significantly positive relationship with “avoidance and suppression” and a significantly negative relationship with “perceptional changes” in coping. These findings indicate that promoting “perceptional changes” as a coping strategy may play an important role in reducing nurses’ stress responses caused by moral distress.

  The objective of this study was to create a Japanese version of the Hospital Ethical Climate Survey (HECS) (Olson, 1998) and examine its validity and reliability. Data from 951 nurses were analyzed. The fit of the 5-factor second-order factor model to the data was assessed by confirmatory factor analysis using HECS as the first-order factor and “peers” “patients” “managers” “hospital” and “physicians” as the second-order factors. Although one error correlation was specified, fit indices suggested an adequate fit of the model to the data (CFI=0.940 and RMSEA=0.097). Omega reliability coefficient was 0.956. Due to the presence of one error correlation, the scale was modified. Four observed variables were assigned to each factor. A five-factor second-order factor model of the Japanese version of the shortened HECS (HECS-S) comprising 20 items yielded an adequate fit to the data, as indicated by a CFI of 0.951 and a RMSEA of 0.093. Omega reliability coefficient was 0.941. Based on the above, the construct validity and reliability of the Japanese versions of HECS and HECS-S were confirmed.

  The resources of the long-term care insurance are taxes and Insurance Premiums. As Japan is a hyper aged society, its social resources are not rich. Therefore, we must try to ration the care resources efficiently and equitably. It is necessary to make cooperation among relative organizations smoother in community-based integrated care systems, in order to ensure the effective use of resources. But I, an investigator of long-term care certification, sometimes find difficulty in this point. This report takes up one of those cases.

  Do not attempt Resuscitation (DNAR) orders are routinely issued at many hospitals throughout Japan. However, there is a possibility that many treatments will be withheld even for conditions other than the usage of not performing cardiopulmonary resuscitation during cardiopulmonary arrest. One cause of the confusion is the lack of orders to stop medical procedures other than cardiopulmonary arrest. Therefore, the Working Group of the Japan Association for Clinical Ethics published “POLST (including DNAR orders) preparation guidelines” in 2015. After 3 years, we surveyed many hospitals nationwide. As a result of the investigation, it was found that 2/3 of the facilities used DNAR based on some devises. Almost half of the facilities have stopped medical practices other than cardiopulmonary arrests. 88% have trouble with DNAR orders. The Japanese version of POLST is known by almost half of the facilities and is highly evaluated positively.