“Caring” has been recognized as a core concept of nursing, however, its essence has not fully understood yet. This study aimed to redetermine the concept of “Caring” in nursing. The “Practical Knowledge” is formed and the individual nursing practice is created by a nurse accumulating the experiences to face patients. Transforming the nursing practice into the “Practical Knowledge” requires “Insight” and “Introspection.” The nurses’ mind towards patients of “Want to be, or should be considerate and close to patients.” this directs nurses to gain an insight or to introspect. The “Caring” is not just a part of nursing practice, but a nursing practice itself appeared as a series of actions provided by a complex mixture of actions and feelings. The “Caring” in nursing is a general nursing practice as a “Practical Knowledge” based on the active thoughts and wishes towards patients. The thought of how to face patients as a nurse, is in the base of “Caring” and is supporting what is the “Caring.” and this can be said to be a way of life as a nurse.

Purpose: The purpose of this study is to elucidate the ethical issues experienced by Head Nurses in small or medium-sized hospitals, and the measures taken by them to solve the issues including the characteristics of the measures. Method: Data were collected by semistructured interviews from 8 Head Nurses working in hospitals with less than 200 beds. And they were analyzed in a qualitative and an inductive manner. Results: Six categories of ethical issues were identified including: “they have no other option than obeying their hospital’s management policy, while they doubt it” and “they have anxieties about whether it is appropriate to continue or to provide treatments for patients in their hospitals.” And, six categories of measures were identified including: “they should tell their ideas to the staff, and consider the issues collaboratively.” Discussion: The issue that “they have anxieties about whether it is appropriate to continue or to provide treatments for patients in their hospitals” is thought to be a characteristic ethical issue for Head Nurses working in small or medium-sized hospitals. This suggests a need for the nurses to have formal opportunities to discuss their anxieties with other Head Nurses and their superiors.

This study sought to clarify the educational opportunities, level of ethical knowledge, and ethical issues experienced by clinical nurses based on hospital size. Subjects were 230 nurses employed at larger（301 beds or more）and small to medium-sized（300 beds or less）hospitals. Subjects completed a questionnaire containing items from the Japanese version of “Ethics and human rights in nursing practice.” The results showed that nurses in larger sized hospitals were more experienced in tackling ethical issues, with significantly greater experience with reference to “respecting/not respecting informed consent,” “respect for the patient’s rights and dignity,” “determining when death occurs,” “acting against personal/religious values,” and “patient care with a possible risk for health” as compared to nurses in small to medium sized hospitals. Larger hospitals presented more educational opportunities regarding ethics, and level of recognition of the understanding of the terminology and importance of ethics education. Furthermore, the level of interest in ethics was higher in larger hospitals. With more educational opportunities, there was an increased interest in the theoretical knowledge of ethics and it was easier to perceive ethical issues. It is necessary to enhance the educational content in order to heighten nurses’ sensitivity to ethical issues.

This study aimed to develop a scale for measuring the ethical sensitivity of clinical nurses, and clarifying its reliability and adequacy. From literature and other sources, we extracted 100 cases of ethical issues experienced daily by clinical nurses, and ran them through a panel of experts and preliminary studies to create a test scale of 28 items. We used this test scale in an anonymous and self-recorded study on 1,911 nurses at seven facilities, and obtained a valid response rate of 63.1％. Based on the results of analysing the items and explorative factors, we extracted 19 items in the three factors of “sense of dignity,” “professional duty” and “loyalty to patients.” We confirmed internal consistency with a Cronbach’s alpha reliability coefficient of 0.80 for all 19 items. Furthermore, the results of using known groups to review the adequacy of the constructs revealed a significantly higher score for nurses who have been trained in the ethics of nursing, compared to those who have not. These findings confirmed the reliability and adequacy of the scale, which can be used to measure the ethical sensitivity of clinical nurses.

The development of advanced practice nursing roles internationally holds promise for improving patient care, the health of the local community, and the health of a society. Advanced practice roles have developed for a variety of reasons, although reasons may differ somewhat among countries. One compelling reason for the proliferation of advanced practice roles from the nursing profession’s standpoint is that higher levels of education and expertise permit a more comprehensive evaluation of, and attention to, a person’s needs. However, a worry about advanced practice roles is that other professions may want to control the APNs practice and direct it to other purposes than nursing goals. This has become a concern in the U.S. that must be guarded against. The situation in the U.S. provides a warning for advance nursing practice in other countries, including Japan. Advanced practice nursing is a nursing role and should not be subverted for other objectives or for the objectives of other professions. Because the nursing profession exists to provide a ‘good’ or service to society all nursing actions have ethical aspects. Accepting the ethical nature of everyday nursing practice is critical to the development of ethical expertise and thus for meeting nursing goals. We can be criticized when we get diverted from our goals whatever the reason. Advanced practice nurses with their higher levels of expertise and education are ideally positioned for leadership. A critical component of advanced practice nursing education, formal and ongoing, is the development of ethical expertise. Ethical expertise, in turn enables leadership of others, nurses as well as colleagues and allied professionals. In this talk I discuss the inseparable nature of nursing and ethics, proposing that advanced practice nurses are in the ideal leadership position to develop ethical environments of care. The skills and capacities needed to develop confidence in ethical decision-making are suggested, as are strategies for continuing to develop advanced practice nursing ethics expertise. Advanced practice leadership is proposed as a way to support and advance ethical practice settings.