Moral distress is a conceptual tool that brings the emotional landscape of the moral realm to the fore and draws attention to the socio-political and contextual features of moral agency. This essay gives a brief history of the development of the normative and empirical research on moral distress. It pays special attention to the standard definition of moral distress originally delineated by Andrew Jameton in 1984 and the early empirical research that operationalized this definition. Finally, it summarizes some of the lenses through which moral distress is currently perceived, articulated, and critiqued.

This study aimed to qualitatively examine ethical behavior in nursing practice among nursing bachelor students. Data were collected via semi-structured group interviews, conducted from June to November 2016, and were qualitatively and inductively analyzed. Participants were 10 fourth-year students, 9 practical training instructors, and 7 nursing faculty teachers. Consequently, data of 3 parties, 267 codes, 53 sub categories, 15 categories, and 5 core categories “building mutual relations based on respect,” “protection of patients’ rights,” “responsible nursing practice,” “improving nursing practice by team collaboration,” and “learning attitude that is aware of responsibility.” were extracted. Results elucidated that ethical behavior, such as respecting subjects’ requirement when deepening relationships with patients, protecting patient privacy, and acting as an advocator, is required of students in nursing practice.

“Supporting ICT-based death certification” is intended to be conducted in difficult access areas or when medical doctors are unavailable. The challenge is to develop the role of nurses in the field of death verification as part of nursing care and without keeping them as mere assistants to doctors. This paper discusses the problem in light of the experiences of other countries and presents suggestions for the further development of nursing care. In the UK, confirmation or verification of death can be undertaken by trained registered nurses. We examined the current practice in Japan and compare it to the current practice in the UK and to the experience of the implementers. The result showed that in Japanese practice, nurses and doctors could work in collaboration to conduct death confirmation and postmortem examinations scientifically and impartially. In doing so, nurses become advocates of the deceased, and gain the trust of society, thus ensuring the expansion of the roles of nurses based on their professionalism and autonomy.

The purpose of this study is to examine the actual condition, sex-role attitudes and ethical behavior of nurses who experienced sexual harassment from patients. The study employs a questionnaire survey, and the contents are “The scale of egalitarian sex-role attitudes̶a short form(SESRA-S)” and the “Ethical Behavior Scale”. The subjects were 834 nurses(94.8% female, 4.7% male)in six prefectures in the Tohoku region of Japan. 62.6% of the participants had experienced sexual harassment. Of the 632 answers given by respondents who experienced sexual harassment, “There was a sense of discomfort” accounted for over 60%. There were no differences in the SESRA-S score and the Ethical Behavior Scale score depending on whether or not sexual harassment was experienced. There was a weak positive correlation between the SESRA-S score and the Ethical Behavior Scale score, ρ=0. 302. The cause of nurses’ sexual harassment from their patients could not be attributed to their individual sex-role attitudes and ethical behavior. In the future, it was suggested that patient factors should be taken into account when planning sexual harassment prevention measures for nurses in Japanese hospitals.

This study examines organizational support for ethics from the perspective of nurse managers in Japan and explores ways to cultivate moral resilience. A questionnaire survey of nurse managers in hospitals with more than 200 beds was conducted. The questionnaire included items on demographic characteristics, importance and frequency of organizational support for ethics, and a 12-item Organizational Climate Scale adopted from Fukui (2004). The final sample included 758 nurse managers (response rate: 56.9%). Exploratory factor analysis extracted four factors of organizational support for ethics: ethical attitude as a nurse manager, effort in wards, effort as a nursing department, and the hospital’s ethics management system. There were no significant differences across the factors regarding the associations of frequency or of importance of ethical support with the respondents’ characteristics, including age and length of clinical experience. However, among 4types of organizational climate categorized by the OCS-12, the “Active” group scored higher than other groups on all four factors. The results suggest that nurse managers’ ethical attitudes and their organizational support for ethics might be influenced only by the organizational climate. This conclusion implies that less controllable environments and more flexible organizational management might facilitate support of ethical decisions, which, in turn, might cultivate nurses’ moral resilience.