The purpose of this study was to examine the effectiveness of a 22-item scale to evaluate the ethical behavior of clinical nurses in Japan. 600 nurses participated in the study; after reviewing the data for inconsistencies and obvious deficiencies, 479 of the questionnaires were used for analysis. Based on this analysis, the author developed a 22-item ethics scale subdivided into three categories: respect for the patient’s autonomy’ （9 items）; justice for all patients （4 items）; and do-no-harm, do-good （9 items）. Cronbach’s α coefficients for the three categories were respectively: 0.78, 0.77, and 0.80 with an overall reliability of 0.88. Furthermore, a significant correlation was found between the three categories. While there is room for further examination and improvement of the justice-for-all-patients category, statistical analysis confirmed the usefulness of the ethics scale to reliably measure the ethical behavior of nurses in Japan.

The purposes of the present study were to identify factors influencing the decision by elderly patients to undergo cardiac surgery, and to discuss the support required to facilitate such decision-making. The subjects were eight elderly patients. Semi-structured interviews were conducted, and the results were analyzed qualitatively and inductively. The following eight factors influencing their decision-making to receive cardiac surgery were extracted: prediction of cardiac surgery; receiving an explanation of the cardiac surgery indicated; reliability of cardiac surgery; expectations regarding cardiac surgery; playing roles that they still have; hope of continuing to live; being supported by family members; and obtaining information from people who have undergone cardiac surgery. To encourage elderly patients to make the decision to undergo cardiac surgery, it is necessary to provide support to: understand their anticipatory feelings; encourage them to accept the fact that they should undergo cardiac surgery; help them understand the meaning of receiving cardiac surgery; and encourage them to utilize social support.

This study raises the issue of whether the ethics of care provide a practical perspective for nursing. Some authors consider the ethics of care appropriate to express essential nursing requirements and incorporate them into their theories, whereas others have criticized their use in nursing. However, many of these discussions appear to pay attention to only a part of the issue, and not the ethics of care as a whole set of rules. This paper is focused on one of the discussions in the ethics of care that has been given little attention in nursing, i.e., the ethical elements in the aspects of care proposed by Tronto. By comparing these elements with the principlism of Beauchamp and Childress, it is suggested that the ethics of care fruitfully contribute to nursing ethics.

The purposes of this study were to develop a scale （MSS-NH） on moral sensitivity for nurses who work at nursing homes and to confirm its validity and reliability. First, we developed a draft of the MSS-NH. This version consisted of 48 items selected from data generated by interviewing 20 nurses who were working at nursing homes. Next, we tested the scale’s validity and reliability. Data were obtained from 861 nurses who were working at nursing homes. Construct validity was tested with exploratory factor analysis, which resulted in a 4-factor solution with 17 items. The 4 factors were: organizing teams to protect elderly people’s dignity; supporting the life that is unique to each person; practical use of elderly people’s capabilities; and making decisions about artificial hydration and nutrition. Cronbach’s alpha coefficient for all 17 items was 0.85; for the 4-factor groups, it varied between 0.72 and 0.83. Confirmatory factor analysis indicated that a 4-factor model was valid and that this model provided the best fit for the sample （GFI＝0.95, AGFI＝0.94, CFI＝0.95, RMSEA＝0.05）. These results verify that the MSS-NH is internally consistent and has construct validity.