Background:Information sharing is one of the most important means of public health nurses collaborating with other healthcare professionals and community members. There are complicated ethical issues in the process.Research objectives:To describe the ethical dilemmas associated with client information sharing that Japanese public health nurses experience in daily practice and to clarify their decision-making process to resolve these dilemmas.Research design:Data were collected using a three-phase consensus method consisting of semi-structured interviews, self-administered questionnaires and a group interview.Participants and research context:We surveyed administrative (...) public health nurses in Shizuoka Prefecture, Japan. The semi-structured interviews were carried out with 12 administrative public health nurses, and the self-administered questionnaires were sent to all 899 administrative public health nurses. The group interview was carried out with eight administrative public health nurses.Ethical considerations:Ethical approval was granted by the ethics committee of the School of Health Sciences, Nagoya University, Japan (8-158, 9-130).Findings:Information-sharing ethical dilemmas occurred most often when clients’ decisions did not coincide with the nurses’ own professional assessments, particularly when they faced clinical issues that were inherently ambiguous. In their decision-making processes, nurses prioritised ‘protection of health and life’.Discussion:These findings suggest that, above all, they sought to address urgent risks to clients’ lives while upholding the principle of client autonomy as much as possible. In such cases, the nurses made decisions regarding whether to share information about the client depending on the individual situation.Conclusion:Public health nurses should protect the client’s health while taking into consideration their relationship with the client. (shrink)

With growing globalization, the governments of many countries are tending to place a disproportionately large emphasis on economy, which often results in budget cuts in health, education and social welfare. Such a tendency has provoked arguments by many individuals concerned. The neo-conservatism represented by ex-US President Reagan and ex-UK Prime Minister Thatcher in the 1980s, known as Reaganomics and Thatcherism, caused public funds for health care and education to be substantially reduced. In developing countries a so-called structural adjustment policy, promoted (...) by the World Bank and the International Monetary Fund, is leading to shrinking budgets for health, education and social security in general. (shrink)

A senior physician with a government role in Japan made a widely reported and misleading statement about Thailand’s policy on HIV/AIDS patients. He claimed that in Thailand the policy is to spend public money on the prevention of HIV infection while allowing AIDS patients to die untreated. The author, a community nursing specialist in Japan with first-hand knowledge of HIV/AIDS policy in Thailand, thought that this statement would influence attitudes negatively in Japan. However, speaking out about this misrepresentation of the (...) facts carried certain risks. Although freedom of expression is valued in Japan, in practice it is not easy to contradict senior medical professionals. The author uses his experience of this difficult professional situation to teach nurses how to approach speaking out in the public interest. (shrink)