This study aims to identify normative principles and related ethics issues intrinsic to traditional nursing science, and explore suggestions from this to choose an appropriate ethics theory, which could assist in developing a responsible nursing ethics. Eight basic norms, based on Florence Nightingale’s understanding of nursing, were derived from a text analysis of Notes on Nursing, where we identified passages with ‘ought’ as ethics index items. The eight norms may be classified into two groups: behavioral and cognitive. The behavioral norms concern nursing activities, including some bioethics principles. The cognitive norms are concerned with nursing as a specialty related to scientific and managerial issues in nursing. Cognitive norms can provide nurses with a basis for common nursing practices. However, neither provide a basis for ethical thinking about morally responsible behaviors. Further, the relations between norms and laws in the text suggest that other than relying on the laws of God, nurses should be autonomous in managerial activities to improve patient health. Virtue ethics is unsuitable for forensic psychiatric nursing practice. Owing to its universalizability, the most suitable ethics theory to supplement moral principles in nursing needs to be utilitarian and thus one that includes deontology.

This study aimed to develop the Japanese Patient Dignity Scale（J-PDS）, and to evaluate its reliability and validity. The Japanese version of this 35-item questionnaire was prepared by translating its international version. Adult inpatients admitted to 14 hospitals were mailed the self-report J-PDS with demographic questions and the Japanese version of the Rosenberg Self-Esteem Scale（RSES-J）. Responses were collected from 307 patients（return rate: 47.5％, valid response rate: 99.7％）. Exploratory and confirmatory factor analyses, and examination of the internal reliability and criterion-related validity of the tool were conducted. Expectation of dignity comprised 5 factors: respect for humanity, respect for privacy, politeness and consideration, respect for justice and fairness, and respect for autonomy, with 21 items. Satisfaction with dignified care comprised similar factors for the 21 items, but somewhat integrated 3 factors. The Cronbach’s alpha coefficients for expectation and satisfaction were 0.92 and 0.94, respectively. Scores on several factors of both expectation and satisfaction showed significant weak positive correlations（p＜0.05）with the RSES-J scores. The models of expectation and satisfaction indicated relatively high model fit（CFI＝0.90 and 0.91, respectively）on the confirmative factor analysis. These results suggest that the J-PDS has sufficient reliability and validity.

Objective: To elucidate the efforts of nurse managers in the implementation of the Clinical Ethics Guidelines, as well as changes in the awareness and behavior of nurse managers and teams due to implementation of the Guidelines. Methods: Subjects were 10 nurse managers who participated in the implementation trial of the Clinical Ethics Guidelines, and the data obtained from semi-structured interviews were analyzed qualitatively and inductively. Results: A total of five categories were identified for the efforts of subjects in the implementation and the changes perceived by subjects: “awareness of managers regarding implementation”, “arrangements made by managers for the implementation”, “approaches made by managers toward staff”, “method of use of the Guidelines”, and “changes in the managers and teams”. Discussion: These findings suggest that the Clinical Ethics Guidelines have the functions of reminding nursing staff of important matters, and serving as a guide that enables daily reflections of care. The implementation was also thought to have resulted in an improved ethical sensitivity and behavioral changes in the subjects and teams. These findings indicate that in order for the entire team to focus on ethics, it is important for nurse managers to communicate with the team.

Nurses often see ethics as abstract and academic—not as something directly applicable to their daily work. Nurses frequently find the specialized terms and language of ethics distancing—not descriptive of the ordinary problems working nurses experience or the worries nurses everywhere actually have about whether they are making the right decisions and doing the right things. And, if nurses think about ethics at all, they sometimes think their ethical problems and responsibilities are culturally specific—not the same as ethical problems and responsibilities of nurses around the world. This lecture will first address these challenges to ethical nursing practice:（1）that ethics is abstract, not applicable;（2）that ethics is distant, not descriptive; and（3）that ethics is cultural, not universal. These challenges, however, are simply background to a fourth challenge, which is that bioethics in general, and Nursing Ethics in particular, typically focuses on big, dramatic ethical dilemmas and, by doing so, implies that there are no right answers in ethics. What I will call “Neon Ethics” directs attention to flashy ethical issues, often ones that are exceedingly difficult to resolve, about which reasonable people deeply disagree. I will draw attention instead to “Everyday Ethics,” the kind of ethical problems conscientious nurses face regularly. These might include how to help a patient reshape her self-concept in the face of disability, how to handle tensions between patients and family members, or how to handle medical orders that do not seem right for the patient. Finally, one of the most common challenges to ethical nursing practice, around the world, is the problem nurses describe as being caught in the middle of conflicts between what their patients need, what patients’ family members want, what nurse managers and colleagues think nurses ought to do, and what patients’ physicians order or expect. This fifth challenge of being the nurse in the middle sounds like a terrible place to be. Actually, the patient is the one most inescapably in the middle, and it is indeed a scary place to be when there is conflict among those who decide what will happen to the patient. Fortunately, the patient has a nurse in the middle with him or her—a nurse to be a steady presence, to advocate, to comfort, to care, and to do the hands-on work day-by-day of assessing and treating the patient’s illness and shaping the patient’s environment. Perhaps being “the nurse in the middle” is the best（and in some ways the most powerful）place to be when it comes to actually caring for patients.