The purposes of this study are to develop the first revision for nursing students of the Japanese version of the revised Moral Sensitivity Questionnaire （St-J-MSQ） so that students can understand and answer appropriately despite their lack of experiences, and then to examine its reliability and validity. The proposed St-J-MSQ is based on the Japanese version of the revised Moral Sensitivity Questionnaire （J-MSQ）. The subjects of this study were 1,022 students who were in a nursing university or a nursing diploma school. The questionnaire was constructed of three parts: J-MSQ, J-MSQ with an explanation （J-MSQ/E）, and St-J-MSQ. The J-MSQ/E and St-J-MSQ were validated from the surface validity test with a focus group interview. The answers of the J-MSQ, J-MSQ/E and St-J-MSQ were analyzed by major factor analysis. The St-J-MSQ（Cronbach’s alpha 0.79） showed similar factor structures to the J-MSQ original. However, it is necessary to revise the questionnaire, because it could not measure “Moral Responsibility” accurately.

With regard to family surrogate decision-making about terminal care, several studies have been conducted on “how to assist family surrogates in their decision-making.” However, there were few studies targeting surrogate decision-making itself prior to David Wendler et al.’s investigation encompassing “The Effect on Surrogates of Making Treatment Decisions for Others.” Still, this study was limited to statistical analyses, and there have been only a few studies focusing on individual cases. Therefore, the present study took a hermeneutic approach to dissecting individual cases and examining a methodology for analyzing psychological factors that influence decision-making in such cases. The possibility of facilitating agency decision-making was discussed. Specifically, we focused on family surrogate decision-making regarding “whether or not to administer artificial hydration and nutrition to a patient（AHN）with end-stage, severe dementia” and recorded all communications among family members, including non-verbal interactions, in order to perform conversation analyses. Through interpreting psychological and social factors affecting each family member, we were able to examine and analyze various factors that influence surrogate decision-making. Furthermore when a family shares the narrative for “surrogate decision-making”, we concluded that they can make a more suitable decision.

This study’s objective is to examine the uncomfortable feelings and dilemmas experienced by nurses in their teamwork, as well as to clarify their common structures. An interview survey was conducted with 10 nurses, and a narrative analysis was performed in regard to the structures of the nurses’stories of incongruities. As a result, the findings of the structural narrative analysis suggested three structural patterns in the reported episodes: 1）the nurse did not take any action（19 episodes）; 2）the nurse took some actions, but they had no effect（10 episodes）; and 3）the nurse took some actions and they had some effect（2 episodes）. Regarding the latter two episodes, one nurse noted that her colleagues were a “good model” while another referred to her previous successful experiences when dealing with the current incongruity. In addition, the reported causes for such incongruities were categorized into three themes: （X）owing to the conventional habits in their nursing teams, （Y）owing to the length of clinical experience, and（Z）owing to nurse–doctor relationships.

A self-administered questionnaire survey, cross tabulation, and correlation analysis were conducted to examine the actual conditions of hospital nurses’ recognition of respect for the decisions made by older adult patients in their terminal phase and of their related factors. More than 70％ of nurses respected terminal-phase decisions when only the patient’s decision was presented, but this fell to between 30 and 50％ when there was a conflict between the patient’s decision and the family and/or doctor’s wish to provide life-support care. In addition, it was observed that nurses in a position with high capabilities for “cooperation for the care of patients in their terminal phase,” “explanatory support of the terminal phase,” and “nursing care of patients in the terminal phase” tended to respect the decisions of older adult patients requesting terminal-phase life-support care more, while nurses in a position with lower capabilities for “cooperation for care of patients in the terminal phase” tended to respect their decisions to refrain from terminal-phase life-support care more. To promote respect for the terminal-phase decisions of older adult patients, these findings suggest the need for the following: ethical education for the nursing profession, opportunities to search for ways to solve ethical problems regarding patients’ rights, and ways for nurses to acquire the ability to make terminal care-related decisions from the viewpoint of patients that reflect the patients’ values, such as the way patients live their lives and their thoughts on life.

The purpose of the present study is to clarify the efforts made by nurse administrators during end-of-life care at geriatric health service facilities. A questionnaire survey was provided to 39 nurse administrators working for 39 facilities that provide end-of-life care. A total of 36 valid responses were received（response rate 92.3％）and analyzed. According to the survey results, overall, respondents took meticulous care to ensure that residents live a safe and comfortable daily life, drawing out needs and concerns from residents and their families. The respondents also supported residents’ families when they experienced emotional changes associated with the residents’ changing health conditions. Furthermore, the respondents helped their facility staff resolve emotional struggles and concerns. Finally, the respondents hoped that their staff would develop their own views of life and death through end-of-life care, which suggested the need to organize death conferences or create other opportunities for their staff to share their thoughts and feelings with colleagues.