This study aimed to: (1) develop and evaluate the Moral Distress Scale for Psychiatric nurses (MDS-P); (2) use the MDS-P to examine the moral distress experienced by Japanese psychiatric nurses; and (3) explore the correlation between moral distress and burnout. A questionnaire on the intensity and frequency of moral distress items (the MDS-P: 15 items grouped into three factors), a burnout scale (Maslach Burnout Inventory - General Survey) and demographic questions were administered to 391 Japanese psychiatric nurses in 2007-2008. These nurses experienced relatively low levels of moral distress despite the fact that they were commonly confronted by morally distressing situations. All the circumstances in which the participants experienced moral distress were included in the 'low staffing' factor, which reflects the characteristics of Japanese psychiatric care. The frequency score of the low staffing factor was a significant predictor of burnout.

The purpose of this study was to investigate the actual conditions of handling personal information in clinical training and to clarify the ethical issues involved, so as to examine the ethical education system at nursing universities. Educational directors of 83 nursing universities in Japan were asked to respond to a mailed survey. Questionnaire items included: the manner in which patient information was obtained and recorded, the nature of the information requested, the manner in which the forms were kept, and the question whether patients were informed that their personal information would be accessed by nursing students.Replies from directors of 44 universities(a collection rate of 53.0%) were received and analyzed. Results showed that over 75% of the nursing universities directed their students to record 11 items of personal patient information, including name, age, sex, family members, date of hospitalization, and occupation. Also, more than 40% of the universities allowed the students to delete every other character of the patient's name thus making easy identification of individual patients difficult. During clinical training, 95.5% of the nursing universities held their students individually responsible for the keeping of the forms, and after clinical training, 63.6% of the universities continued to hold the students responsible. Only 34.1% of the patients were informed that their personal information was being accessed by students. These results show that the actual conditions of handling personal information in clinical training involve ethical issues such as recording unnecessary personal information, accessing personal information without informed consent, and individual keeping of the forms by students.

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