Components of moral behavior among Japanese public health nurses and differences according to work experience and position

Objectives Most public health nurses (PHNs) in Japan do not receive systematic ethical education after beginning work in the community. Therefore, we are developing an educational program for them. The purposes of this study were to clarify the components of moral behavior among Japanese PHNs and to identify differences by their work experience and position.

Method We distributed to 2,193 municipalities, a 96 item, 5-point Likert scale (1=strongly disagree; 5=strongly agree), developed from a survey and interviews for PHNs and content analyzed using five concepts by Rest et al (moral sensitivity, moral judgment, moral motivation, moral character, and moral implementing moral decision). We included a demographic section. Return of the anonymous questionnaires were considered consent to participate.

Results Usable data was 3,423 (32.2% of mailed questionnaires). Item analysis and exploratory factor analysis, revealed five factors: (1) caring for client/family (C/F), population in partnership and team members; (2) understanding and respecting values of C/F and population; (3) motivation to face ethical problems; (4) determining people's healthcare prioritizing and values and (5) deciding whether care is right or not based on C/F or population perspectives. Relationships among factor scores and length of working experience (0-1, 1-5, 6-10, 11 and over) and position (staff, assistant manager, manager) were analyzed using ANOVA. PHNs who had longer work experience or higher position scored significantly higher than those who had shorter work experience or lower positions.

Conclusions Components of PHNs moral behavior reflected characteristics of their clients and practice. It was presumed that their moral behavior was influenced their experience. Based on these results, we are developing an ethics educational program to promote PHNs' effective practice in Japan.