Moral distress is one of the key topics in nursing research. In order to discuss the concept of moral distress, we invited internationally renowned nursing ethicist Dr Megan-Jane Johnstone to a zoom-meeting session in which a group of Japanese nursing ethics colleagues participated. This paper describes Johnstone’s responses to our open questions on this concept regarding such as: ambiguity of the concept, problems that ambiguity brings to nursing practice, problems with moral distress research, and the role of appropriate disagreement on ethical issues in workplace. We learned that it is important to understand and use ethics language not superficially but correctly and unambiguously for constructive dialogue in workplace. Her message ‘Disagreements are often the beginning of our thinking, not its end’ and her reference to the value of ‘Harmony’ were most impressive. We would like to express our sincere gratitude to Dr Johnston for providing a valuable platform for dialogue to exchange and share views on moral issues in nursing.

This study aimed to compare the ethical sensitivities of nursing students and nurses, the ethical issues they anticipate during disasters, and identify educational issues. Participants were clinical nurses and first- to fourth-year nursing students at University A. This cross-sectional study used self-administered and unadministered questionnaire surveys. Ethical sensitivity was assessed on a 3-factor, 23-item scale, and ethical issues in disaster situations were assessed through open-ended questions. Analysis methods were ANOVA and free response statements were analyzed through text mining. The results showed that “sense of dignity” was highest among nursing administrators and fourth-year students, followed by third- and second-year students; fourth-year students were considered to have an increased awareness of dignity due to their extensive practical training experience. Nursing managers had the highest “professional duty”, followed by staff and fourth- and third-year year students. “Loyalty to patients” was the highest among fourth- and third-year students, but was not significant. The most common ethical issue during a disaster is the maintenance of privacy. The need for educational interventions to progressively increase ethical sensitivity was suggested.

The objective of this study is to clarify the ethical issues in pediatric hospitalization perceived by mid-career nurses and their responses. A qualitative descriptive design was employed, with participants of 13 nurses with 3 to 10 years of clinical experience in pediatric nursing. Analysis of semi-structured interviews revealed three ethical issues: [restrictions on the living environment necessary for children’s growth and development], [healthcare professionals’ words and actions that cause children to feel pain and fear], and [situations where children’s wishes are difficult to be respected]. Additionally, three categories of mid-career nurses’ responses were revealed, [trial and error to create a living environment necessary for children’s growth and development], [interactions with children and healthcare professionals to reduce pain and fear] and [interactions with parents and healthcare professionals to respect children’s wishes]. The findings suggested that by respecting children as individuals and placing importance on their growth, development, and lifestyle, nurses can recognize ethical issues in pediatric hospitalization and reduce children’s pain and fear.

It is believed that enhancing emotional intelligence can improve students’ ethical judgment skills. The aim of this study was to elucidate the relationship between emotional intelligence and ethical decision-making criteria, based on Kohlberg’s theory, among nursing students. We conducted a self-administered questionnaire survey of nursing students at X University to assess the extent to which students with high emotional intelligence value each of the three decision-making criteria in the theory: preconventional, conventional, and postconventional. Even if it is not possible to evaluate ethical judgment ability using the sequentiality proposed by Kohlberg’s theory, it is suggested that multifaceted criteria can be established for judgment, allowing for the evaluation of the relative importance of each, without being constrained by the sequential nature of the criteria.

This study aimed to clarify the factors that influence nurses’ behavior toward removing physical restraints in general wards. A self-administered questionnaire survey was conducted on 394 nurses at 15 facilities that were randomly selected from 50 “general hospitals” in the national hospital function evaluation system who agreed to participate in the study. Binomial logistic regression analysis was performed to predict the influence and extent of six independent variables on “behavior toward removing physical restraints (active and non-active groups)”. The number of responses was 205, with a valid response rate of 96.6%. The results indicated that consulting colleagues and superiors about shortening the time of physical restraints or considering alternatives (removal behavior ①) were influenced by “knowledge about physical restraints”, “ward culture and communication in the workplace”, “shortening the time of physical restraints”, or “considering alternatives”. The factors that influenced proposals at a team conference (removal behavior ②) were “experience with incidents related to physical restraints”, “empathy support scale: holistic understanding”, and “ward culture and workplace communication.”

This study aimed to identify the challenges faced by certified neonatal intensive care nurses when making treatment decisions regarding withholding or withdrawing treatment for children with critical illness admitted to the neonatal intensive care unit. Data were collected from 14 certified neonatal intensive care nurses through semistructured interviews and analyzed qualitatively and descriptively. The nurses’ responses revealed several key difficulties: reported disagreements about treatment policy, lack of discussions between parents and healthcare providers, and the implementation of treatment policies without consideration of the facility’s practices or the child’s condition. Furthermore, conflicts arose in relationships, with statements indicating that parents struggled with treatment decisions and that nurses faced similar conflicts. It is essential for medical personnel to understand and support parents during these distressing times. Building relationships and fostering an organizational culture that encourages discussion between parents and healthcare providers is crucial.

This study clarified the factors influencing the moral distress experienced by nurses, by analyzing survey data of nurses at advanced treatment hospitals across Japan to examine the relationship between moral distress and factors such as gender, years of experience, job title, Certified Nurse Specialist (CNS)/ Certified Nurse (CN) qualifications, night shift status, and department. Moral distress was measured using the Japanese version of the MMD-HP scale. Responses from 882 nurses were analyzed, with a mean moral distress score of 73.0(ranging from 0 to 363), a median of 58.0, and a standard deviation of 57.8. Factors influencing nurses’ moral distress included job title and the presence of CNS/CN qualifications. Additionally, the highest mean scores for moral distress were observed in the emergency department, community liaison department, palliative care unit, psychiatric unit, and management/education unit. These results suggest that, to address moral distress among nurses, both organizational support for common moral distress and tailored interventions based on individual characteristics are necessary.