The purpose of this study was to clarify ethical problems and value conflicts experienced by nurses working in psychiatric wards in Japan and to elucidate the factors influencing these problems. Focus group interviews and individual interviews were conducted with 28 nurses with at least 3 years of clinical experience in psychiatric wards. Content analysis was performed for each episode recounted during the interviews. An analysis of 68 pertinent episodes yielded eight categories of ethical problems, including “patients’rights,” “medical treatment” and “discharge and long-term hospitalization.” The values experienced by the subjects consisted of seven categories; “patients’ rights,” “patients’ dignity,” “patients’ well-being,” “professional values,” “personal values,” “cultural values” and “rights of other persons.” Value conflicts were found between these different values. In addition, “actual constraints,” which were not value factors, conflicted with nurses’ values.

This study takes a historical perspective to examine how characteristics of the good nurse were described in selected influential Japanese nursing textbooks published in 1877-2006. The ethical ideal, the good nurse, reflects nursing values and virtues with implications for today’s Japanese nursing education and practice. The major question in this study asked which good nurse characteristics were described in these selected Japanese nursing textbooks. Content analysis was conducted to extract good nurse characteristics from 18 influential Japanese textbooks selected at four historical periods when there was a change in nursing education. Four categories of good nurse characteristics were identified:（1）personality and humanness,（2）knowledge, skill and attitudes of a caring professional,（3）good physical and healthy appearance, and（4）competence to foster nurse-patient interpersonal relationships. Categories found over time were “the nurse’s personality and humanness” and “knowledge, skill and attitudes of a caring professional”, Since 1990, increasing emphasis has been placed on the category “competence to foster interpersonal relationships”. While the textbooks have continued to describe virtue ethics, the descriptions of the good nurse were not empirically based. Further study is therefore needed on this important topic.

The theme ‘What makes a good nurse?’ is often discussed by nursing students, clinical nurses, and the general public. However, because each person has their view of a good nurse, the concept ’good‘ is complex. The answer to this question may vary depending on the situation, the respondent, and his/her occupation. Focusing on patients’families, i.e., persons with the closest relationship to the patients, we asked the question to those who had recently lost a family member. ’Good nurses’, as viewed by the family members, were kind, smiley, and had excellent communication skills.

Toshima Village, Kagoshima Prefecture, Japan, is a remote area encompassing an isolated group of pelagic islands. Seven of the islands are inhabited. While each island has a remote-area clinic with a full-time nurse, only one island has a full-time doctor. Towards their final days, the residents have to leave their islands for hospital admission in the main land of Kagoshima city. Factors underlie this situation are 1）aging and depopulation 2）lack of medical doctors, 3）lack of social resource, and 4）cadaver processing problems. In this situation, the residents’ basic human rights are at risk. As the only health care professional in the islands are nurses, it is imperative to expand their role.

The paper throws a light into the concept of patient-centered nursing from the narratives of nurses regarding withdrawing and withholding artificial food and fluid in terminally ill patients. The nurses who raised questioned the ‘patient-centered nursing’ has the underlying feeling of ‘communality of death’, ‘my death’ and ‘one’s nature’. Those nurses knew the meaning of death that evolved over time and were caring for the patients based on their clinical experience rather than relying on the concept of ‘patient-centeredness’. While patientcentered nursing is the standards of ethical conduct in today’s nursing shifted from the historical disease/cure oriented model those nurses’perceptions suggested the possibility of different care approach.

Clinical practice is an important opportunity for nursing students to learn ethics. This pilot study describes how nursing students learned ethical ‘seeing’ and ‘thinking’ about a case that they encountered in pediatric clinical practice. A seminar teaching format in which students and the teacher engage in dialogue to address the issue was employed during the practice. A modified four-step problem solving model was a useful tool to guide students to reason through the situation to a choice of right action. Further study is needed towards the students’ learning ‘ethical doing’ the selected action.

This presentation explores the ethical concepts of the public good, responsibility and trust to examine the ethics of collaboration between academic nursing and clinical nursing both of which are vital to nursing education, to the nursing profession and to the public which nursing serves. Changes in Japanese nursing education and the professional roles of those involved in this education are examined along with some historical highlights. The factors that assist students to become a good nurse are detailed within the context of the professional socialization process. Potential areas of difficulty in collaboration are outlined from an ethical perspective and a beginning guideline of ethical principles and virtues are summarized to assist individual nurses strengthen their colleagueship and collaboration in nursing. All of these comments are grounded in an idea from Buddha: We do not have to wait until we are pure at heart to do good. Becoming pure at heart is a life long journey which we may never fully attain.