Journal of Clinical Ethics
Online ISSN : 2435-0621
Print ISSN : 2187-6134
Current issue
Displaying 1-9 of 9 articles from this issue
Original articles
  • Kumiko Kitano, Sakae Mikane, Keiko Takeda
    2023 Volume 11 Pages 5-15
    Published: 2023
    Released on J-STAGE: October 01, 2023
    JOURNAL FREE ACCESS

      The purpose of this study was to examine the validity and reliability of the Nursing Competency Scale without physical restraint in acute care hospitals. The subjects were 5821 ward nurses at 52 facilities who worked with acute care hospitals nationwide. The contents of the survey were 70 items related to basic attributes and nursing competencies that do not require physical restraint. For validity, exploratory and confirmatory factor analyses were examined by covariance analysis. Conformity was determined by comparative fit index and root mean square error of approximation and reliability was assessed by Cronbach’s alpha reliability factor. 2156 copies (37%) were collected, and 1692 (29%) were valid responses. Four factors and 25 items were extracted. We examined the suitability of the four-factor secondary factor model to the data, and the result (CFI=.929, RMSEA=.055) met the statistically acceptable level. Cronbach’s α was 0.93 across the scale. Thus, the reliability and validity of the nursing competency scale without physical restraint were confirmed.

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  • Kei Takeshita, Noriko Nagao, Toshihiko Dozono, Yasuhiko Miura, Keiko K ...
    2023 Volume 11 Pages 16-33
    Published: 2023
    Released on J-STAGE: October 01, 2023
    JOURNAL FREE ACCESS

      Focus group interviews were conducted with home healthcare professionals (8 physicians, 13 nurses, and 11 care managers) on 1) what they value in their work in home healthcare, 2) ethical issues they have faced, 3) efforts they are making to resolve them, and 4) support they would like to receive to resolve the issues and have qualitatively analyzed. The results showed that the fundamental values are to “focus on the patient and family” and “build consensus among the persons involved”. This study also revealed that the ethical issues can be categorized into “issues related to collaboration”, “issues related to the environment and system”, “issues related to home healthcare professionals”, “issues related to the patient and family”, “issues related to the patients themselves” and “issues related to the family and home healthcare professionals”. In addition, this study suggests that the ethics support that home healthcare professionals need includes free access to consultation in daily practice, a place for multidisciplinary discussion with the participation of third parties, ethics education for professionals, and personnel with expertise in both home healthcare and clinical ethics.

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  • Jungen Koimizu, Chiaki Yamamoto, Wakano Mukouyama, Masayo Yamamoto, Sh ...
    2023 Volume 11 Pages 34-44
    Published: 2023
    Released on J-STAGE: October 01, 2023
    JOURNAL FREE ACCESS

      This study conducted a prospective survey on the ethical behavior of Japanese medical staff to examine the effect of clinical ethical support provided by an ethics consultation team (ECT) on the ethical behavior of medical staff. A questionnaire survey using the Rinriteki Koudou-shakudo Kaiteiban (the Revised Edition of the Nurses’ Ethical Behavior Scale ; EBS-R) was conducted with the medical staff in a Japanese hospital (Hospital A). The questionnaire was answered twice : directly after the ECT had settled in Hospital A (the first term ; FT) and 10 months later (the latter term ; LT). The LT answers were assorted according to having (LTEC+) or not having (LTEC−) taken advantage of the clinical ethical support by the ECT. The questionnaire results obtained for the FT, LTEC+, and LTEC− were compared. The number of answers collected was 270 in the FT and 242 in the LT. The LT tended to show a higher total EBS-R score than the FT. The LTEC+showed statistically higher scores, in total and for “risk avoidance” and “good care”, than the FT, while the LTEC− scores did not differ from the FT. The findings suggest that clinical ethical support by the ECT helps medical staff improve their ethical behavior.

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  • Teruyuki Ounishi, Ayumi Kono, Fumiko Okamoto
    2023 Volume 11 Pages 45-53
    Published: 2023
    Released on J-STAGE: October 01, 2023
    JOURNAL FREE ACCESS

      The purpose of this study was to examine the relationship between multidisciplinary collaboration and moral distress among medical staff (physicians, nurses, and clinical engineers) in the emergency and intensive care fields, and their attitudes toward end-of-life care. A total of 193 medical staff members in the fields of emergency and intensive care medicine at a community health care support hospital were included in the study. A self-administered, anonymous questionnaire survey was used to ascertain basic attributes, collaboration among multiple professions, moral distress, and attitudes toward end-of-life care. A multivariate logistic regression analysis was conducted, with the independent variable being collaboration in multidisciplinary collaboration, and the dependent variables being moral distress and attitudes toward end-of-life care. The analysis showed that medical staff with high awareness of multidisciplinary collaboration had lower moral distress than those with low awareness (odds ratio=0.87, 95% confidence interval=0.74-1.00). The results suggest that sharing and discussing the treatment and care of terminally ill patients and their families with multiple professions may reduce moral distress.

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  • Sakura Uemura, Yoshimi Takeda, Yoko Okuno, Atsuko Fukuoka, Mariko Mats ...
    2023 Volume 11 Pages 54-65
    Published: 2023
    Released on J-STAGE: October 01, 2023
    JOURNAL FREE ACCESS

      This study aims to identify the effect and problem of ethics consultation team (ECT) intervention in ethics conferences. Interviews of nine ethics conference participants were conducted and the obtained data were qualitatively analyzed. The categories of effects were as follows : “Can be considered in a timely”, “Can be understood the opinions and discussed by multidisciplinary team”, “Can be discussed cases carefully and objectively”, “ECT will facilitate the consultation in ethics conference”, “Can be organized concepts and specific procedures for ethical issues”, “Can be obtained various awareness”, “The medical team can provide support according to the patient’s values and preference”, “Unified recognition and shared support methods among healthcare professionals”, “Can be considered as a consensus of the entire hospital”, “Healthcare professionals can provide support with confidence”, “Reduces the psychological burden on healthcare professionals”, “Gets new knowledge and can utilize it for other cases”and of problem were as follows : “Lack of knowledge of ethics”, “Cannot exchange opinions with ECT equally”, “No results can be obtained with expectation”, “Cannot be applied too much individuality with cases”.

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  • Yukari Miura, Koichiro Itai, Takanori Ayabe, Motohiro Fukaya
    2023 Volume 11 Pages 66-78
    Published: 2023
    Released on J-STAGE: October 01, 2023
    JOURNAL FREE ACCESS

      In clinical ethics consultations in Japan, activities are carried out to provide appropriate advice in order to assist concerned parties in resolving anxieties and conflicts, such as withholding or discontinuing treatment, supporting patient decision-making, and so on. The purpose of this study is to conduct semi-structured interviews with senior clinical ethicists to clarify their competencies. The participants were 38 people from 20 medical institutions. Using theme analysis, 49 subcategories, 11 categories, and 4 themes were extracted from the verbatim transcripts. Clinical ethicists listens to the client’s anxieties regardless of their own perspective, sees through to the essence of the problem, and builds ethical reasoning. They support the discussion process itself in order to activate the exchange of opinions among participants through conferences and derive concrete measures for resolution. Above all, it is important to divide roles and promote cooperation within the ethics consulting team in order to demonstrate individual abilities. It was deduced from the narrative that they used a wide variety of competencies to support medical staff facing ethical issues.

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