Katsumasa Ota

Essential roles of clinical nurse instructors in Japan: A Delphi study

In Japan, the clinical nurse instructor is a staff nurse who teaches in clinical practicums. However, there is no consensus on the essential roles that clinical nurse instructors are expected to perform. We conducted a three-round Delphi survey to clarify the essential roles of the clinical nurse instructor in clinical practicums in undergraduate nursing education. The participants were an expert panel of 48 professionals in nursing education and clinical practicums, who rated the importance of 58 role items that were established through a literature review and pilot survey. Thirty one of these items were identified as essential roles, based on agreement of 80% or more of respondents. Further investigation revealed nine of the 31 items to be core roles, defined as the minimum essential roles that must be performed by clinical nurse instructors, however busy they become. The nine core roles are related to proper preparation for the clinical practicum, patient safety, and coordination with the nursing school faculty. It is important for the nursing school faculty to support and work in cooperation with clinical nurse instructors to help them fulfill these roles.In Japan, the clinical nurse instructor is a staff nurse who teaches in clinical practicums. However, there is no consensus on the essential roles that clinical nurse instructors are expected to perform. We conducted a three-round Delphi survey to clarify the essential roles of the clinical nurse instructor in clinical practicums in undergraduate nursing education. The participants were an expert panel of 48 professionals in nursing education and clinical practicums, who rated the importance of 58 role items that were established through a literature review and pilot survey. Thirty one of these items were identified as essential roles, based on agreement of 80% or more of respondents. Further investigation revealed nine of the 31 items to be core roles, defined as the minimum essential roles that must be performed by clinical nurse instructors, however busy they become. The nine core roles are related to proper preparation for the clinical practicum, patient safety, and coordination with the nursing school faculty. It is important for the nursing school faculty to support and work in cooperation with clinical nurse instructors to help them fulfill these roles.

Educational content in nurse education in Japan: A Delphi study

The purpose of this study was to clarify the minimum necessary educational content in the area of nursing ethics in a basic nursing education program, and the level of students’ mastery of this content, based on a Delphi study in both educational and clinical settings. A Delphi study was conducted in three rounds with faculty members who teach nursing ethics at all 158 four-year nursing universities in Japan as targeted panelists. In this study the opinions on nursing ethics of nursing instructors responsible for hospital education at all 82 special functioning hospitals were reflected in the panelists’ opinions. Consensus was obtained on 41 items from a total of 63 items in 4 proposed frameworks. There were 20 items related to the Concept of nursing ethics, 7 items related to Ethical codes, 13 items related to Ethical issues and methods to resolve them, and 1 item related to Efforts and issues in practical and educational settings. Consensus as to desired level of mastery was reached on a total of 40 items. This agreed-upon level involved understanding of the concept for 22 items, the ability to explain the concept for 16 items, and the ability to act based on the concept for 2 items.

Examination of an Electronic Patient Record Display Method to Protect Patient Information Privacy

Electronic patient records facilitate the provision of safe, high-quality medical care. However, because personnel can view almost all stored information, this study designed a display method using a mosaic blur (pixelation) to temporarily conceal information patients do not want shared. This study developed an electronic patient records display method for patient information that balanced the patient’s desire for personal information protection against the need for information sharing among medical personnel. First, medical personnel were interviewed about the degree of information required for both individual duties and team-based care. Subsequently, they tested a mock display method that partially concealed information using a mosaic blur, and they were interviewed about the effectiveness of the display method that ensures patient privacy. Participants better understood patients’ demand for confidentiality, suggesting increased awareness of patients’ privacy protection. However, participants also indicated that temporary concealment of certain information was problematic. Other issues included the inconvenience of removing the mosaic blur to obtain required information and risk of insufficient information for medical care. Despite several issues with using a display method that temporarily conceals information according to patient privacy needs, medical personnel could accept this display method if information essential to medical safety remains accessible.

Information-sharing ethical dilemmas and decision-making for public health nurses in Japan:

Background: Information sharing is one of the most important means of public health nurses collaborating with other healthcare professionals and community members. There are complicated ethical issues in the process. Research objectives: To describe the ethical dilemmas associated with client information sharing that Japanese public health nurses experience in daily practice and to clarify their decision-making process to resolve these dilemmas. Research design: Data were collected using a three-phase consensus method consisting of semi-structured interviews, self-administered questionnaires and a group interview. Participants and research context: We surveyed administrative public health nurses in Shizuoka Prefecture, Japan. The semi-structured interviews were carried out with 12 administrative public health nurses, and the self-administered questionnaires were sent to all 899 administrative public health nurses. The group interview was carried out with eight administrative public health nurses. Ethical considerations: Ethical approval was granted by the ethics committee of the School of Health Sciences, Nagoya University, Japan (8-158, 9-130). Findings: Information-sharing ethical dilemmas occurred most often when clients’ decisions did not coincide with the nurses’ own professional assessments, particularly when they faced clinical issues that were inherently ambiguous. In their decision-making processes, nurses prioritised ‘protection of health and life’. Discussion: These findings suggest that, above all, they sought to address urgent risks to clients’ lives while upholding the principle of client autonomy as much as possible. In such cases, the nurses made decisions regarding whether to share information about the client depending on the individual situation. Conclusion: Public health nurses should protect the client’s health while taking into consideration their relationship with the client.