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ObjectivesThe purpose of this study was to explore the effectiveness of learning ethics of nursing practice using narrative writing. MethodsStudy design was qualitative descriptive research. The participants were 90 graduate students who took nursing ethics classes, of whom 86 graduate students (4 males and 82 females) agreed to this study. The data gathered for analysis were their narratives described as feeling uncomfortable in clinical settings and their comment sheets after narrative group work in nursing ethics classes. We used qualitative content analysis to identify graduate students’ awareness gained through narrative writing and narrative group work. ResultsAs a feature of the scenes described by graduate students, there were often conflicts that patients’ autonomy were not respected, or that they were not able to engage in sincere engagement. The narrative writing was effective to make graduate students aware of the following two aspects: 1) habits and trends in one’s own thoughts and 2) organizational and administrative issues related to ethical issues. ConclusionsLearning ethics of nursing practice using narrative writing that focused on nurses’ sentiments helped reveal nurses’ thoughts as well as their attitudes and approaches to patients. These findings suggest that narrative writing in nursing ethics education could lead to ethical practice. Additionally, our results indicate that narrative writing in research may be helpful as a strategy to clarify ethical issues and the awareness of nurses in clinical settings.

Our findings indicate that individuals often attempt to clarify their preferences in order to make it easier for their significant others to make end-of-life care decision on their behalf, so that they may receive their desired care.

Although advance care planning (ACP) can lead to more patient-centered care, the communication around it can be challenging in acute care hospitals, where saving a life or shortening hospitalization is important priorities. Our qualitative study in an acute care hospital in Japan revealed when specifically physicians and nurses start communication to facilitate ACP. Seven physicians and 19 nurses responded to an interview request, explaining when ACP communication was initiated with 32 patients aged 65 or older. Our qualitative approach employed descriptive analysis to identify major themes, which included “initiation by patients” and “initiation by healthcare professionals.” In the latter case, seven specific triggers were identified: (1) when the patients’ medical condition changed in terms of symptom relief, (2) when the patients’ medical condition changed in terms of prognostic prediction, (3) when serious events occurred, (4) when a choice of treatment was presented, (5) when the location for end-of-life care was chosen, (6) when the patients’ cognitive function deteriorated, and (7) when serious events settled down. Within this group of healthcare professionals, physicians were more focused on changes in their patients’ medical condition, whereas nurses focused more on their patients’ desire for a long-term perspective. Nurses encouraged patients to consider ACP themselves, which developed into an approach to respect patients’ autonomy. In acute care hospitals, it appeared to be desirable to have an early discussion where patients could understand the significance ACP, which would matter even after their discharge from the hospital.

Background: Nursing students encounter ethical problems in their interactions with various people in clinical practice. In Japan, few studies have examined ethical problems between students and nursing educators in clinical practice. The aim of this study was to investigate the characteristics of ethical problems encountered by Japanese nursing students from the perspectives of patients and the students themselves. Methods: A descriptive, exploratory study was employed in this research. Questionnaires were distributed to 274 third-year students who had completed 6 months of clinical practice in 2012, 2013, or 2014. The situations in which students described ethical problems were classified into those involving patients and their family members and those involving the students themselves and other trainees. Results: A total of 58 students described 198 situations involving ethical problems (89 toward patients, 102 toward students, 7 other). Students expressed concern in terms of their basic attitudes toward nurses and respect for patient individuality. The largest number of unethical teaching behaviors involved violations of the principles of benevolence and respect for students. Conclusions: The results suggest the need for student assistance in understanding ethical problems, for strengthening of links with intramural ethics education, for the establishment of a consultation system, and for leveraging of faculty development education.