Purpose: This study aimed to verify the reliability and validity of the Japanese version of the Ethical Decision-making Climate Questionnaire (EDMCQ) for decision making in intensive care units (ICU). Methods: The Japanese version was created by translating the English version of EDMCQ. A survey was conducted by mailing the questionnaires, targeting ICU nurses. The test was retested 14 days later. Results: The test was distributed to 439 ICU nurses. Overall, 204 responses from nurses at 25 facilities were received and analyzed (effective response rate: 46.5%). Cronbach’s α coefficient for the entire scale was 0.91, and the intraclass correlation coefficient was 0.80 (n=101, valid response rate: 23.0%). The indices for model fit in the confirmatory factor analysis were CFI: 0.836, GFI: 0.783, AGFI: 0.741, and RMSEA: 0.071. Conclusion: The Japanese version of the EDMCQ can be considered to be a practical scale for evaluation of ethical climate in Japan.

Purpose: To elucidate the factors associated with self-evaluations of end-of-life care (EOLC) practices for non-cancer patients experienced by nurses in general hospitals. Methods: A questionnaire survey was conducted involving 1161 nurses from general hospitals. Results: Comparing the realities of 648 cancer cases with those of 306 non-cancer cases in terms of end-of-life care practices, it was found that significantly lower EOLC self-evaluation scores (on a 10-point scale), fewer instances of eliciting patients’ intentions or wishes, and fewer team discussions related to EOLC practices were observed in the non-cancer cases. (p<0.001). For each disease, pneumonia and heart disease tended to be lower. Self-evaluation of EOLC practices was consistently associated with eliciting patients’ intentions and wishes (β=0.21 for cancer, β=0.16 for non-cancer), and team discussions (β=0.25 for cancer, β=0.35 for non-cancer) for both cancer and non-cancer cases. Conclusion: General hospital nurses’ self-evaluations of EOLC practices for non-cancer patients were lower compared to those for cancer patients. It is necessary to enhance their skills in eliciting patients’ intentions and wishes and to implement a system of care for team discussion.

Our former independent palliative care center has become a palliative care ward in our new general hospital, and deceased patients continue to be discharged through the building’s main entrance. We compared the impact of this change on the discharge experience of bereaved families. As a result, the number of bereaved families who felt uneasy when their relatives were discharged from the hospital increased from 13% to 23%. On the other hand, the number of bereaved families who had a feeling of uneasiness when encountering the discharge of other deceased patients decreased from 52% to 28%. Although positive feedback was received for discharge using the main entrance, our findings emphasize the need for thorough consideration by medical staff of the manner of discharge in general hospitals. In response to bereaved families’ requests, our hospital has introduced a discharge system that allows families to choose whether to leave through the main entrance or through other entrances, aiming to improve the discharge experience.