Ethical Problems Development and Evaluation of Nursing Action Agenda to Ethical Decision Making in Hospital- Participation to the Clinical Ethics Committee

1. 对全日本3115家医院进行问卷调查，内容涉及设立临床伦理委员会、活动细节、护理委员会工作人员等，其中764家接受了问卷调查（回收率24.5%），并对759份问卷进行了分析。设立临床卫生委员会的机构有242家（31.9%：医院221家，护理部9家，护理部12家）。他们的活动以“研究中的伦理审查”最多，其次是案例咨询、提供指南等信息、教育启发。只有67个机构（38.8%）回答说，委员会正在发挥作用。1996年以前设立的300张病床以上的医院和外部委员会的医院都给出了肯定的回答。在没有设立委员会的509个设施中，61.2%（68.4%）的314个设施正在进行安装或已经做好了安装准备。没有委员会的设施回答说他们遇到了一些困难尽管意识到它的必要性，但在安装上还是有很多困难。通过对9家已设立临床伦理委员会的医院的护理主任和委员的访谈，发现医院设立临床伦理委员会的程序有4种：1)院长领导、2)护理部建议、3)护士个人学习会议、4)市级管理指导。安装是通过会议和精心策划来准备的，例如在大型医院设置多个委员会，或在护理部门额外设置一个伦理委员会，以赋予护理活动权力。我们对两家医院一年多的调查表明，通过参与护理伦理提升项目委员会和参加护理人员伦理赋权的持续学习会，一家医院在一年后成立了护理部门伦理委员会，另一家医院表明更多的员工开始熟练地和道德地行事。少

1. From questionnaires sent to 3115 facilities throughout Japan concerning installation of a clinical ethics committee, details of activities and nursing committee staff, 764 facilities answered (recovery 24.5%), and 759 answers were analyzed. Facilities where the clinical et hics committee had been set up were 242 (31.9% : hospitals 221, nursing department 9 and 12 of both). Regarding their activities, "ethical examination in researching" was most many, and then consultations of the case, information like guideline offering, and education and enlightening followed.Only 67 facilities, 38.8% answered the committee was functioning. The facilities that had 300 beds or more, and/or set up before 1996, and had an external committee gave positive answers.314 facilities 61.2%, among 509 facilities (68.4%) that did not have the committee, were in the installation schedule or had already done the preparation of installing. 195 facilities without committee answered that they had some difficultie … More s in installation in spite of being aware of its necessity.2. From our interview to nursing directors and committee members of 9 facilities that have installed a clinical ethics committee, four types of installation procedure were found : 1) by the lead of the hospital director, 2) by suggestion of nursing department, 3) through personal study meeting of nurses, 4) with direction of municipal management. The installation was prepared through meetings, and meticulous planning such as installing multi committees in a large-scale hospital, or installing an additional ethics committee of nursing department to empower the nursing activities.3. Our survey in two hospitals for more than one year has clarified that, through participation in nursing ethical improvement project committee and attendance to a continuous study meeting purposing nursing staffs ethical empowerment, one hospital established the ethical committee in the nursing department after one year, and another facility indicated more staffs started to act proficiently and ethically. Less