Masami Matsuda

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.

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.

Health Promotion and Education in Thailand in Comparison with the Japanese Health Care System and Health Informatics

The 6th Global Conference on Health Promotion held in Bangkok in 2005 proposed the following three points as key issues of health promotion in Thailand: (1) make the promotion of health a core responsibility for all government departments, (2) make the promotion of health a requirement for good corporate practice, and (3) make the promotion of health a key focus of communities and civil society. The 7th Global Conference on Health Promotion, held in Kenya in October 2009, reflected the following five sectors for current health promotion in Thailand: (1) community empowerment, (2) health literacy and health behavior, (3) strengthening health systems, (4) partnerships and intersectoral action, and (5) building capacity. As indicated in the Nurses of the Community Project in Thailand, six essential systems were identified to increase involvement and build ownership of the Nurses of the Community program (NOC). Key success, including (1) strong and active memorandum of understanding among key actors at the implementing level, (2) guidelines and strategies to make every system practical, (3) the systems of NOC require intricate designs supported by long-term community-based research and development, and (4) options for policy development at both national and local levels, is vital for NOC retention. In Thailand, the widespread growing interest in strengthening local community infrastructures, institutions, networks, and capacities reflects at least four influencing strategies, which sustain community strength in the country. Based on the Japanese experience, it is expected that these policies and programs will develop in the future into the integrated approach of primary care (by the nurse practitioner), health promotion, national health insurance, and care insurance.

HIV/AIDS and Professional Freedom of Expression in Japan

A senior physician with a government role in Japan made a widely reported and misleading statement about Thailand’s policy on HIV/AIDS patients. He claimed that in Thailand the policy is to spend public money on the prevention of HIV infection while allowing AIDS patients to die untreated. The author, a community nursing specialist in Japan with first-hand knowledge of HIV/AIDS policy in Thailand, thought that this statement would influence attitudes negatively in Japan. However, speaking out about this misrepresentation of the facts carried certain risks. Although freedom of expression is valued in Japan, in practice it is not easy to contradict senior medical professionals. The author uses his experience of this difficult professional situation to teach nurses how to approach speaking out in the public interest.