The majority of research on the moral development of nurses is in line with Kohlberg's theory. However, Gilligan noted that care and justice perspectives coexist in moral conflict, and during the growth process, each complements each other and promotes moral development and maturation. Chally, referring to Gilligan's theory, which has the perspective of relationship-focused care, argued that the moral development of nurses should be considered from both care and justice perspectives. In this paper, we analyzed publications that used Gilligan protocol to conduct research on moral conflicts experienced by nurses. Given the importance of care and justice perspectives in moral reasoning, Gilligan's theory, which incorporates both perspectives, is useful for analyzing moral reasoning in nurses. Our analysis suggests that attachment and connections based on relationships with patients and self-care are essential elements of care, and self-care is important in moral decision making. The inequality between nurse and physician roles was an issue raised with the justice perspective. Since nurses' roles are strongly influenced by their affection toward and connections with their patients, it is important not to overemphasize either perspective.
Background: Healthcare professionals use the ethics of justice and care to construct moral reasoning. These ethics are conflicting in nature; different value systems and orders of justice and care are applied to the cause of actual moral conflict. We aim to clarify the structure and factors of healthcare professionals’ moral conflicts from the lens of justice and care to obtain suggestions for conflict resolutions. Method: Semi-structured interviews about experiences of moral conflict were conducted with Japanese nurses recruited using the snowball sampling method. Interviews were conducted based on the real-life moral conflict and choice interview. Interviews were recorded and transcribed verbatim, then analyzed based on the interpretive method of data analysis. Verbatim transcripts were read four times, first to get an overall sense of the conflict, then to understand the person's thoughts and actions that explain the conflict, and third and fourth to identify perspectives of justice and care, respectively. Each moral perspective was classified into categories according to Chally's taxonomy. Results: Among 31 responses, two that did not mention moral conflict were excluded, and 29 responses were analyzed. These responses were classified into six cases with conflict between both justice and care perspectives or within one perspective, and into two cases without conflict between perspectives. The “rules” category of justice and the “welfare of others” category of care were included in many cases of conflict between two perspectives, and they frequently occurred in each perspective. Conclusions: Moral conflicts are intertwined with justice and care perspectives in a complex manner because of the conflict between both perspectives, the conflict within the same perspective, and their overlap. Organizational, professional, and patient-related factors influenced conflicts between justice and care. Additionally, multiple overlapping loyalties created conflicts within justice perspectives, and multifaceted aspects of care-provider’s responsibility and patient need created conflicts within care. Decision-making biased towards one perspective can be distorted. It is important to consider ethical issues from both perspectives to resolve conflicts, especially the effective use of the ethics of care, is recommended.
: Forensic nursing is the application of forensic science to nursing. It provides direct patient care with relation to violence, abuse, crime, victimization and exploitation. Forensic nurses integrate forensic and nursing sciences in their assessment and care of victims and perpetrators. In the U.S.A., Canada and Europe, forensic nursing practice involves advocating for the collection of evidence and reporting of crimes. Additionally, forensic nurses treat victims and perpetrators for their trauma, their families, communities and the systems that respond to them. Through its practice, forensic nursing contributes to public health by preventing health hazards caused by violence and crime. This report considers the possibility of the development of forensic nursing in Japan. We propose that the development of forensic nursing is necessary.
Background Criminals in Japan with mental disorders face penal servitude in prison or treatment under the Medical Treatment and Supervision Act, depending on their ability to take responsibility for their criminal acts. Forensic psychiatric nurses caring for this group may face various ethical issues. Objective This study aimed to identify ethical issues forensic psychiatric nurses in Japan encountered. Method We used the Ethical Issues Scale to conduct a survey among forensic healthcare ward nurses and analyzed the data using descriptive statistics. We also conducted semistructured interviews with individual nurses who provided signed consent and responded to the initial survey on ethical issues they encountered. These data were analyzed using Berelson's content analysis. Results Of 175 nurses, 131 answered our survey. The most frequently encountered ethical issue was “protecting patients' rights and human dignity,” and the most disturbing ethical issue was “providing nursing care with possible health risks.” Seventy-seven percent of the nurses chose to discuss with peers when resolving the ethical issues. Seventeen nurses who were interviewed described these forensic psychiatric nursing-related ethical distresses and conflicts: difficulty in discharge management, prevention of violence and self-harm, compulsory treatment, patient care, and negative emotions toward patient. Conclusion Forensic psychiatric nurses in Japan face difficulties regarding respecting patients' rights. They strive to respect patients' rights by using their expertise as nurses while sharing their difficulties with colleagues. It is important to develop a support system for social reintegration to solve ethical issues.
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