Ethical Issues in Practice: A Survey of Public Health Nurses in Japan


Correspondence to:

Kiyomi Asahara, St. Luke's College of Nursing, 10-1 Akashicho, Chuo-ku, Tokyo, 104-0044, Japan. E-mail:



The purposes of this study were to identify specific components and frequencies of ethical issues that public health nurses (PHNs) encountered in their practice, relationships between ethical issues and demographic data, and ethics education and workplace environment.

Design and Sample

Cross-sectional survey for PHNs at local governmental agencies in Japan. Usable data were 3,409.


Public health nurses completed the frequency of ethical issues, experience of ethics education, workplace environment, and demographics.


Item and exploratory factor analysis for the frequency of encountering ethical issues revealed: (1) discrepancy of intention between client and his/her family on treatment or care; (2) differences in views between PHNs and their organization's administrators regarding providing services; and (3) discrepancy of caretaking views between PHNs and various professionals. All factors were related to work experience and one factor was specifically related to the type of local government employing PHNs. Only 11.1% of PHNs received ethics education via continuing education programs. PHNs reported that programmed continuing education systems were not sufficiently available.


Systematic continuing ethics education programs for PHNs need developing, tailored to the specific characteristics associated with PHNs’ ethical concerns, such as nurses’ working experience and the type of employing local government.