Eubios Journal of Asian andInternational Bioethics
EJAIB Vol. 32 (5) September 2022
www.eubios.info

ISSN 1173-2571 (Print) ISSN 2350-3106 (Online)

Official Journal of the Asian Bioethics Association (ABA)

Copyright ©2022 Eubios Ethics Institute(All rights reserved, for commercial reproductions).

Contents
page
Editorial: Bioethics and Sustainability
125- Darryl Macer
Anthropo-symbiotic ethics: a path to thesustainability of life
126
- Luís Fonseca, Guilhermina Rego, Rui Nunes
Occupational stress experiences of civilengineers in the implementation of road
construction projects
131- Teodoro M. Momo, Jr. and Amelie T. Bello
Tri-people Hybrid Con lict Resolution Approach:
Enabling A Culture of Peace in Alamada, North
Cotabato, Philippines
138- Mark Anthony N. Lataza and Bartolome B. Lataza
Discharge support practices of nurses in NICUs
in Niigata Prefecture, Japan144- Mio Tanakaa, Subasinghe Pathirannahalage
Kalpana Jeewanthi Subasinghe, Tomoko Sumiyoshi,
Nao Seki, Utako Shimizu, Hiroshi Kobayashi and
Akurugoda Mahanakathige Shyama Deepanie
Pathiranage
EJAIB Editorial Board
153
Ordering information
154

Editorial: Bioethics andSustainability-

f

f

f

f

f

f

f

f

f

More than a decade after the completion of the
Global Decade of Education for Sustainable
Development (ESD), and a few decades after the irst
World Environment Conferences that introduced theterm sustainability, can we really say that our world,
and the practices that we engage in, are sustainable?
As we can see from increased activism to call upon
the urgency of policies and practices to stop humanmade climate change, we realize that these young
people are the grand children of the young people
who irst campaigned for sustainable futures. How
many generations is enough? Schumpeterian
dynamics suggests a paradigm shift often takes
several generations, and we can certainly see that in
the concepts of sustainability. These are much morethan just environmental issues, including social

sustainability. How do our ethical choices anddecisions affect the impact that we have on otherpeople, the environment and the future?
After many months of the war in Ukraine I am
still in disbelief given the very rich philosophical andliterary traditions of Russia, but sadly every culture
has had times of evil aggression. Perhaps we have toadmit that war is something which human beings
seem to repeat forever, even more than love forever.
How can we thrive on the suffering of others? The
importance of new solutions is explored in the irst
paper in this issue on anthropo-symbiotic ethics. The
next paper on occupational stress re lects on
something which not just facing civil engineers, but
is facing all those who work in industry. The paradoxof road construction continues, and thirty years ago I
published a paper on the ethics of transport choices.
We use cars and roads, even if we're shifting toelectric vehicles, and we need transport systems tobring people to different places. Perhaps the lessonof the pandemic that we can work from home moreis going to reduce some of the traf ic.
Om the other hand bringing people to different
parts of the world is a way to overcome con licts, anda case study by the Lataza brothers looks at con lictresolution in the Philippines. Is a sustainable cultureof peace enhanced by communication and exchange
between people? We hope so.
The last paper is a medical ethics issue and weare all very blessed by having access to intensive
care units (ICUs) but what happens once we leave
the ICU and go to other parts of a hospital, medicalor social system? Japan has a good health insurance
and social insurance system, but I can see in someparts of United States that once you leave hospital,
you're back on the streets, literally, with only
voluntary organizations to help you, if anybody. As
we have an aging population, we need to havegreater integration of social services and medical
services into the holistic care approach’ Let's hopethat we really can move forward with the re lections
on these and other papers in endeavors to make asustainable society. - Darryl Macer

126

Eubios Journal of Asian and International Bioethics 32(5) (September 2022)

Anthropo-symbiotic ethics: a pathto the sustainability of lifethat a symbiotic ethics, in which mankind is at the
top of the moral hierarchy, can make a decisive
contribution to the problem.

Luís Fonseca, Guilhermina Rego, Rui Nunes
Faculty of Medicine, University of Porto, Portugal
Email: luisoliveirafonseca@gmail.com

1. The concept of humanity
In contemporary occidental societies there is a
general predisposition towards an excessively idyllic
vision of the world and the human being. On the one
hand, H. Sapiens is unrealistically seen as a species
innately endowed with pure goodness and, on theother hand, subsists a primacy of the beautiful overthe ugly (in the aesthetic and moral sense of life),
camou laging aversive conditions such as violence or
cruelty.
There’s also a tendency for “psychiatrization” ofemotions, such as sadness or anxiety, andpersonality traits, such as malice. However, negative
emotions, such as sadness [that induces crucial
internal and/or external changes to cope properlywith a distressing event] have important phylo- andontogenetic functions. Their role in the survival of
the species and in a person’s harmonious
development is unquestionable. Also, evil is not
exclusive of any psychiatric disorder. It exists as anindependent personality trait, such as being funny,kind or introverted. In fact, there’s a recurrent
dif iculty and resistance in accepting that certain
atrocities are simply a cruel act, without any
underlying disease. People often show surprise
regarding the monstrosity of certain humanbehaviors, asking themselves “how was it possible?”and stating that the perpetrator “couldn't be right in
the head to have done something so grotesque andimpious”, insinuating a psychiatric illness as a causal
factor. This frequent, automatic and unconscious
need to consider these per idious actions
pathological may serve the purpose of preserving
the person’s sanity through a mechanism of denial,
which obliterates the awareness that a human being(the person herself) is capable of such barbaric
behaviors. We often de ine an altruistic demeanor asof great humanity and a malicious action as
pathological and/or of shocking inhumanity. But,
what to think of monsters like Hitler or the cinematic
serial-killer Hannibal Lecter? Are they not simply theembodiment of pure human evil (part of mankind’s
eternal dichotomous nature)? Otherwise, what does
the devil symbolize? Evil (character) or psychopathy(disease)?
The ordinary recognition of the word humanity
as a synonym of benevolence distorts its true
meaning. Human nature is dichotomous andgravitates in a spectrum between two extremes, eviland goodness. Thus, being human includes thewhole package, that is, everything we have of goodand bad. It would be of great importance forhumanity to recognize its true nature without
subterfuges of any kind. Otherwise, unrealistic
solutions for several issues will keep being
presented and the disagreement between human,
animal and environmental ethics will remain
unsolved.

Abstract
The moral status of humans, animals and nature has
been widely debated. Several theories have been
trying to answer to the ethical challenges that arisein the relation between these three entities.
Although there are models with conciliatory views,
none seem to have been suf icient to reach a broadconsensus on the moral hierarchical positioning of
human beings, animals and the environment. Here
we propose a conceptual framework of an anthroposymbiotic ethics to respond, in the most realistic andthoughtful way possible, to the moral obstacles often
placed in the context of the Humans-Nature-Animals
interaction.

Introduction

f

f

f

f

f

f

f

The earth is about 4.5 billion years old [1] and H.
Sapiens evolved from other human species that
inhabited Africa 200,000 years ago [2]. The disparity
between humans’ and planet’s age is therefore
substantial. The latter, along its journey, was affectedby several catastrophes but always regenerated with
viable conditions for Life. Thus, the common rhetoricthat Earth needs salvation is, in fact, a fallacy.
Humans are the ones who are at risk of extinction
due to climate change. Earth, if mankind persists
attacking it, will most likely continue to exist,
renewing itself as it has been doing for billions ofyears.
After its birth, 200,000 years ago, H. Sapiens
spread throughout the world and lived an
animalistic existence until the Neolithic revolution
and the emergence of the irst civilizations in
Mesopotamia, Egypt, India, and China. At this time,about 10 to 12,000 years ago, the species’ culturechanged profoundly. Its nomadic way of life, based
mostly on hunting groups to facilitate survival, gave
place to a sedentary model with agriculture andvillages as its pillars. This was the beginning oforganized social, economic, political and religious
systems that led to a signi icant growth of the
population. This increase continued until today andhas been responsible for the scarcity of natural
resources, the destruction of habitats, deforestation,
environmental pollution and the questionable
exploitation of various animals [2]. Humans have
evolved from an animalistic past to become the mostintelligent, dominant and populous species that has
ever inhabited Earth. However, notwithstanding its
unique cognitive evolution, several of its most
biological primal instincts subsist.
The current environmental imbalance promoted
by humanity is a serious threat to the sustainabilityof life and requires an urgent response. We believe

Eubios Journal of Asian and International Bioethics 32(5) (September 2022)

f

f

f

f

f

f

f

2. Aggression and violence: man vs. animals
The similarity (in varying percentages) between
human and other animals’ genome [3,4], as well as
the shared, to a greater or lesser extent, brain
structures (e.g., brain stem, cerebellum or limbic
system) with other species (even with somephylogenetically distant) [5], supports Darwin's
theory of evolution. Therefore, mankind and animals
share common characteristics, including certain
behavioral patterns. Darwin in “The Descent of Man
and Selection in Relation to Sex” defended that “thedifference of mind between humans and the higher
animals, however great, is certainly one of degree
and not of species”. Thus, if, on the one hand, certain
animals can, after all, be endowed with some degreeof rationality (usually assumed to be an exclusively
human capacity), on the other hand, it will also be noless true that certain more primary behaviors (suchas aggression), usually negatively connoted asanimalists, are an inalienable part of humans’ nature.
According to a study published in Nature [6],humans have a phylogenetic propensity for violence
and those species (H. Sapiens included) withterritoriality and social behavior traits are moreaggressive. Also, the level of lethal violence increased
as humans evolved from their ancestral trunks.
Nevertheless, political and social organization of
mankind appear to have diminished thisaggressiveness, which suggests that culture canshape the inherited inclination towards violence. Inturn, the aggressive phylogenetic trend over time
may be justi ied by its apparently high evolutionary
bene it [7].
The lower degree of violence and con lict incontemporary societies is due not only to a greater
capacity of containing such instincts by social
systems based on rules, and from which collective
and individual advantages arise, but, above all, to thegeneralization of democracies as regimens that give
space for freedom, autonomy, diversity andindividual merit. In fact, history teaches us that
autocracies, sooner or later, by cornering and sti ling
individual’s freedom and legitimate aspirations end
up imploding.
As far as animals are concerned, it is important
to emphasize that they also exhibit gratuitous
violence (evil) and deviant behavior [8,9,10]. For
example, 10% and 17% of deaths in groups of yellow
mongooses and certain lemur species, respectively,
result from lethal violence not related with any
imperative of survival [11]. Thus, it’s not true thatanimals are exclusively candid and innocent and alltheir aggressiveness stems only from the need forsurvival. In the ilm “Dawn of the planet of the apes”,
Caesar, the leader of the simians, after having known
that the war had been maliciously incited by an ape,
said to the human: “I always thought we were better
than humans, but now I see how much alike wereally are.” Furthermore, George Orwell, in his
dystopian book “The Triumph of Pigs”, describes a
gradual intellectual and behavioral transformation of127

an elite of animals into the humans they so abhorred.
These artistic works allude to the possibility that theacquisition of complex and unique cognitive abilities
by any other species would, most likely, result in ahuman-like way of being and acting. Indeed,
considering the theory according to which thedifference between H. Sapiens and other animals is
more of degree than of quality, a dichotomous nature(endowed with a behavioral spectrum between two
extremes, evil and goodness), seems to be common
to both rational and irrational beings of the animal
kingdom. It’s very important to have this realistic
conception, otherwise a Manichean vision between
humans and animals can prevail and block theopportunity to create a judicious ground for aconsensus on ethical matters involving both and theenvironment. The power of H. Sapiens gives him
great responsibility in preserving the balance thatmakes life possible. But it can be dif icult to resist
the latent biological pressure for violence that,throughout evolution, has been an advantage for thedominant species. Only by facing the world as itreally is, without taboos, prejudices and utopian
ideals, we can accomplish meaningful changes.
3. Dystopia of perfection
The incessant and unrealistic demand for an alleged
perfect regime by various political and socialorganizations grossly ignores human nature and its
idiosyncrasies. Dystopias, however well-intentioned
they may be, are, in essence, despotic, so theconstruction of societies based on absolute control
under the pretext of a supposed greater good, suchas generalized well-being, is condemned from thestart as it won’t respond to the vicissitudes and thediversity of human action and thought. Since the
mid-twentieth century, where the paradigm ofautonomy became dominant, most humans are notwilling to abdicate freedom. Few, if any, like to feeltrapped, cornered, or forced to embed other people's
ideals and ways of living that they don't share.
Human history and literature have already shown us
this. In their books “Brave New World” and “1984”,
Aldous Huxley and George Orwell, respectively,
re lect brilliantly and lucidly on human nature andquestion control and individual freedom deprivation
as proper paths to functional and peaceful societies.
Only by not smothering diversity and promoting
education of fundamental human rights from anearly age, underlining the importance of respecting
difference, it will be possible to reach a consensual
ground from which a judicious ethics emerge andtackles properly the problem of the sustainability oflife. Cancel cultures, or other similar prohibitionist
and authoritative movements, will never be abalanced, realistic, plural, solid and temporarily
tenable solution.
4. Contempt for the bottom of the iceberg
Most of the proposed solutions for environmental
problems and the sustainability of the diversity oflife focus on a reactive approach, ignoring the

128

Eubios Journal of Asian and International Bioethics 32(5) (September 2022)

f

f

f

f

f

f

f

f

f

“bottom of the iceberg”, that is, the need forstructural reforms to change the humans’ way of
thinking and acting. Taking the pollution of fossil
fuels as an example, for years it was repeatedlyemphasized that the main solution would be thereplacement of diesel and gasoline vehicles byelectric-powered leets. This narrative has been
adopted by various sectors of society (politicians,
media, etc.) as a kind of inevitable and miraculous
solution that would decisively contribute to themitigation of climate change. It was “naively” ordeliberately ignored that, in fact, what was being
proposed was the replacement of a source ofpollution by another, perhaps, even more serious.
Today, fortunately, public opinion is more aware thatthe methods for producing electricity (dams, windturbines, etc.) [12], the exploration and acquisitionof raw materials for the construction of electricvehicles (e.g., mining, such as lithium) and theimpossibility of recycling their components (e.g.,batteries) [13] are highly harmful to biodiversity[14]. The environmental degradation secondary to
the exploitation of ores for the messianic “green
energies” can have serious consequences for publichealth and even force the evacuation of villages fromcontaminated areas [15].
The obsessive focus on replacing fossil fuels withelectricity, without clear environmental bene its inthe way it is proposed, has masked a huge number ofother problems whose negative impact on theenvironment is signi icant. The current economic
model [based on valuing animals and environmentderived raw materials (e.g. skins and wood,
respectively)], deforestation (e.g. promoting contact
with vectors of microorganisms harmful to humans
and destroying the Earth's “lungs”), irrational
consumerism (which incites the unbridled, repeatedand unnecessary purchase of the most diverse
frivolities, such as electronic devices),
overpopulation (and the inevitable pollution andresources scarcity increases) [16], unbalanced diets[stimulating the exaggerated consumption of meator proposing an exclusively plant-based diet, whichis also harmful to public health and the environment(intensive agriculture; transgenic foods)] or thefocus of medicine on treatment instead of prevention
are some of the upstream problems that are notproperly addressed. Several, like the need to discuss
overpopulation and birth control, are taboo subjects
or simply disregarded because they have no shortterm impact. Of course, in plural societies, based ona primacy of autonomy, an imposing culture is not at
all desirable. However, there are solutions that,
although not immediately consequent, would
certainly contribute to profound positive changes in
the medium and long term, such as early andcontinuous education policies, promoting respect forindividual freedom, cultural diversity, biodiversity
and intergenerational solidarity. This is how evolved
societies can be built, based on a developed literacy
and a culture of transparency and demand, withclear individual and collective bene its.

5. The origin of morality
One of the biggest and most relevant questions inphilosophical ethics is the moral status of living
beings and things and their intrinsic or extrinsic
value. It is important to know what moral status is.
According to the Priberam online dictionary, status
refers to a “law”, “rule” or “condition of a person orentity”, moral derives from the Latin moralis andmeans habits, customs or traditions and morality
designates the expression of judgments that classify
decisions, and the resulting behaviors, as good/correct or bad/wrong. Thus, an individual or anentity can be said to have moral status if its
relevance to society requires that its interests arealways considered and safeguarded. However, it
should be noted that morality is dynamic, that is, itvaries over time and with cultures, so it is a
Herculean task (if not even impossible) tounanimously determine a Common Moral thatserves everyone and everything.
Therefore, bioethics (and ethics in general) has,
as a science, sought to follow the constant social,scienti ic, epistemological and technologicaltransformations and to provide societies withprinciples, re lections and moral solutions suited tothe most varied human and mundane idiosyncrasies
of a world in permanent metamorphosis. There arenot, and presumably never will be, perfect,
unanimous, and universal moral solutions. However,it seems feasible to reach a broad consensus, albeit
with room for dissension, regarding the sustaining
moral foundations, at a certain point in time, of acivilizational harmony within the multicultural spacethat is the current world. For this, it is essential torecognize morality as an ethical judgment ofmankind, resulting from its capacity for re lective
and philosophical thinking and, therefore, nonexistent outside its internal space. So far, there is noevidence that any other species is endowed with the
ethical-philosophical and critical thinking of humanbeings. Thus, the intrinsic or extrinsic value of living
beings and things will be the one that mankind gives
them. In all ethical theories dedicated to the subject,the moral value of the environment, humans and/or
animals results solely and exclusively from theattribution and moral connotation of the proponentsof those theories. In these circumstances, if thepositions taken by the different currents are too
rigid, emasculating the space for questioning anddebate and undermining any possibility ofconsensus, irreconcilable worldviews andirresolvable con licts will emerge.
6. Anthropo-symbiotic ethics
Ethical theories with a more conciliatory andbalanced view about the relation between theenvironment, humans and animals still have two
important limitations.
The irst is considering an interdependence
between the environment (or the planet, if you will)
and mankind (Earth ethics and Ecosophy). However,Eubios Journal of Asian and International Bioethics 32(5) (September 2022)

f

f

f

f

f

f

f

f

it is mankind who, for the moment, is dependent on
Earth, insofar as he cannot abdicate the preservationof viable conditions to survive. Planet Earth,incomparably older than humanity, has always
regenerated throughout its billions of years ofexistence after several catalytic events. Perhaps theillusion of immortality, which daily permeates
human thought, wrongly instills in mankind thepresumption of indispensability. In the future, withspace exploration, it may even happen that humans
settle in other planets and Earth becomes, then,
expendable, losing its inestimable value. However,for the moment, it is essential that H. Sapiens
recognize, without subterfuge or delusional rhetoric,
his insurmountable dependence on the planet.
Failing to do so will most likely maintain the current
course of action towards extinction.
The second limitation of “conciliatory” theories
is placing mankind at a level of moral statussuperimposed on other species and theenvironment. Now, this situation immediately posesa dif iculty: it does not recognize the undeniable
evolutionary supremacy of the human being. Even
the most radical animalistic or environmental
theories, with a pessimistic view of humanity,
identifying it as the main villain of animal andenvironmental destruction, recognize H. Sapiens,
also, as the only species capable of changing thecourse of events. It should be noted that thearchitects of these theories are not trees or animals,
but humans, so the moral hierarchy they elaborate
corresponds to their internal ethical judgment andnot to an inalienable physical rule. Any dominant
species, considering the evolutionary advantage ofanimal aggressiveness [7], would hardly accept
attributing itself an equal (or inferior) moral status.
Thus, it seems to us that a realistic solution would beto embrace an anthropo-symbiotic ethics. In thismodel, the indispensability of a fruitful and mutuallyadvantageous relation between mankind, otherspecies and the environment is recognized. However,
mankind’s superior moral status is unquestionable,
and the inal goal of such relations is human wellbeing ( igure 1.) Humans (as the cognitive “sum”),
invest in a sustainable way in the environment andin animals (seeking that they also bene it from theinvestment) in order to reap the best possible gains.
In extreme situations, which require a choice
between environment, animals and humanity, thebest for H. Sapiens should, in principle, prevail(minimizing, as far as possible, the cost to animals
and the environment). It is unrealistic to think that a
species with the domain and cognitive potential of
human beings, which permanently challenge thelimits of Existence and the cosmos, will not assume asuperior moral status in the cycle of Life. We believethat it is only based on this assumption that afavorable ground can be built for a substantive
agreement that faces environmental challenges and,at the same time, responds, in the most thoughtful
and pondered way possible, to the various ethicaldilemmas and con licts that arise in the dynamics of129

the relation between mankind, animals and theenvironment. An anthropo-symbiotic ethics
recognizes human cognitive superiority, thedichotomous nature of mankind and animals, theevolutionary human domain and theindispensability of a long-term association between
systems of different nature where, in principle, thewell-being of human beings is the ultimate purpose.
It also accepts that exceptional dilemmatic situations
may occur where mankind is neglected in relation toanimals and nature. Imagine, for example, that aperson would have to choose between saving the lifeof Adolph Hitler or his faithful pet dog. What would
be the most morally acceptable choice?

Figure 1: Conceptual model of anthropo-symbiotic
ethicsConclusion
The emergence of several ethical issues in thecontext of the relation between mankind, nature andanimals can have a perverse effect and create aneven more divisive and con licting culture between
different currents. The defense of similar moral
plans for all is incongruous with the human andanimal nature, with the evolutionary dominance ofsome species over others and with the internal
human origin of morality. Aggression and con lict areimportant in maintaining the balance of ecosystems
and their biodiversity. What would it be like if, forexample, we attributed to animals the same intrinsic
value as H. Sapiens, advocating that it would not be
legitimate to kill them for food or interfere with theirreproductive autonomy? What if, in this context,
under a principle of absolute respect for animal life,
the human being abolished the consumption of meat(and ish, by the way) by all carnivores andomnivores and replaced it with other equally
nutritious food? Wouldn't this unbalanceecosystems? And if nature also had an intrinsic value
similar to humans, how would we solve the dilemmaof having to destroy an entire forest to save a humanbeing? What if we had to choose between letting ourneighbor (a normal, compliant man, but with whom
we have no relationship) or our pet die? Placing

130

Eubios Journal of Asian and International Bioethics 32(5) (September 2022)

animals and nature on a moral plan similar to humanbeings would, therefore, add more confusion andarbitrariness in the face of different moral dilemmas,
even assuming that, in fact, it is very unlikely that
there is an entity with an intrinsic and absolute
moral value under any circumstance. The
inviolability of human life enshrined in theConstitution of the Portuguese Republic is a good
example of this. Is it morally reprehensible to kill in awar or in self-defense? On many occasions, there will
never be immaculate ethical judgments. However,this does not dispense the establishment of aconsensual moral hierarchical chain that ,recognizing humans at the top, mitigates the whim in
the ield of moral decisions, making them as
thoughtful and pondered as possible. Within thescope of an anthropo-symbiotic ethics, there will
also be room for freedom, for divergence of opinion
and for a healthy human competitiveness. No animal,
humans included, likes to feel cornered ordiminished in the importance that the evolutionary
domain gives it, so it is necessary, within societies, toguarantee the right to individual autonomy and to
avoid, as far as possible, imposing and prohibitionist
cultures. History shows evolution is a machine
fueled by cognitive capacity and impossible to stop.
We could even question what all the human
intellectual potential would be for if one abdicated,by choice, from discovering the secrets of life and thecosmos (would it be acceptable to dispense animal’s
studies and the use of raw materials from nature,
giving up the discovery and the development of
curative therapies for the most diverse diseases of H.
Sapiens?)
At last, there are those who defend, with greateror lesser vigor that humans should refrain frominterfering with the “natural order” of life. But whatis the “natural order”? If there's one thing Darwinism
taught us is that there is no predetermined design.
And, for those who believe that there is, who can
outright deny that humans' interference in Life is notpart of that prede ined purpose? The natural order
will depend on the relation between the physicchemical circumstances of the cosmos, theinteractions between the various forms of life andthe course of action of the dominant species.

f

f

f

f

f

References
1. Geochronology – What is the Earth’s age? National
Geographic. Published 20/05/2019, 16:41. https://www.natgeo.pt/ciencia/2019/05/geocronologia-quale-idade-da-terra
2. Hermann, H.R. (2016). Dominance and Aggression in
Humans and Other Animals: The Great Game of Life.
3. Chimpanzee Sequencing and Analysis Consortium.
Initial sequence of the chimpanzee genome andcomparison with the human genome. Nature. 2005
Sep 1;437(7055):69-87. doi: 10.1038/nature04072.
PMID: 16136131.
4. Mouse Genome Sequencing Consortium, Waterston RH,
Lindblad-Toh K, et al. Initial sequencing andcomparative analysis of the mouse genome. Nature.
2002;420(6915):520-562. doi:10.1038/nature01262
5. Ribeiro da Silva, Diana & Rijo, Daniel & Salekin, Randall.
(2015). The evolutionary roots of psychopathy.
Aggression and Violent Behavior. 21. 10.1016/
j.avb.2015.01.006.
6. Gómez JM, Verdú M, González-Megías A, Méndez M. The
phylogenetic roots of human lethal violence. Nature.
2016;538(7624):233-237. doi:10.1038/nature19758
7. Georgiev AV, Klimczuk AC, Tra iconte DM, Maestripieri
D. When violence pays: a cost-bene it analysis of
aggressive behavior in animals and humans. Evol
Psychol. 2013;11(3):678-699. Published 2013 Jul 18.
8. Latzman RD, Schapiro SJ, Hopkins WD. Triarchic
Psychopathy Dimensions in Chimpanzees (Pantroglodytes): Investigating Associations with Genetic
Variation in the Vasopressin Receptor 1A Gene. Front
Neurosci. 2017; 11:407. doi:10.3389/
fnins.2017.00407
9. Rebecca Evans, Minna Lyons, Gayle Brewer, Emily
Bethell. A domestic cat (Felis silvestris catus) model oftriarchic psychopathy factors: Development and initial
validation of the CAT-Tri+ questionnaire, Journal of
Research in Personality, 95, 2021, https://doi.org/
10.1016/ j.jrp.2021.104161.
10. Takahashi A, Miczek KA. Neurogenetics of aggressive
behavior: studies in rodents. Curr Top Behav Neurosci.
2014; 17:3-44. doi:10.1007/7854_2013_263
11. Byerika Engelhaupt. How Human Violence Stacks Up
Against Other Killer Animals. Byerika Engelhaupt.
National Geographic. Published September 28, 2016.
https://www.nationalgeographic.com/science/
article/human-violence-evolution-animals-naturescience
12. McCartney, M. P., & Sally, H. (2007). Managing theenvironmental impact of dams (No. 612-2016-40667).
13. Katwala, A. (2018). The spiraling environmental costof our lithium battery addiction. Wired UK, 5.
14. Energy Environ. Sci., 2021,14, 6099-6121
15. Guillaume Pitron. The Dark Side of Green Energies.
Grand Angle Productions. 2020.
16. Understanding global change. University of California
Museum of Paleontology. https://ugc.berkeley.edu/
background-content/population-growth/
17. In Beauchamp, T. L., & In Frey, R. G. (2011). The Oxford
handbook of animal ethics.
18. Rachels, James, 1941-2003. (2003). The elements ofmoral philosophy. Boston: McGraw-Hill.
19. Beauchamp, T. L., & Childress, J. F. (2019). Principles ofbiomedical ethics. New York: Oxford University Press.
20. Att ield, Robin. (2014). Environmental Ethics: An
Overview for the Twenty-First Century.

Eubios Journal of Asian and International Bioethics 32(5) (September 2022)

Occupational stress experiences ofcivil engineers in theimplementation of road
construction projects- Teodoro M. Momo, Jr.

Department of Public Works and Highways
Engineering District, Digos City, Davao del Sur- Amelie T. Bello, EdD, RGC
Institute of Graduate and Professional Education,
Davao del Sur State College, Digos City, Davao del Sur
Email: amelie.bello@dssc.edu.phAbstract
This study explores the occupational stressexperiences of civil engineers in the implementationof road construction projects, highlighting the dayto-day experiences as well as their coping
mechanisms in the performance of such tasks. There
were 12 informants composed of design engineers,
project engineers, materials quality control
engineers and supervisors who underwent in-depth
interviews. Constant comparison technique ofMoustakas (1992) was used to treat qualitative data.
Civil engineers’ cause of stress was related to theorganization’s mandated targets and contractorrelated issues. These stresses affect largely theirwork performance and personal mood andemotions. Thus, they found coping mechanisms bykeeping abreast of their functions and consider
stress as a normal occurrence in their jobs, have aneffective feedback approach, and treasure the role ofthe family. Occupational stress happens when there
is a mismatch between the requirements of the role,capabilities and resources and supports available.
However, with positive workplace, culture may
contribute to attaining and managing stress free
workplace. The results of the study imply that theemployer needs to come up with a program which
could ease the effect of the stressors among
employees. Setting of expectations, determining
favorable deadlines, having open communication,
setting the targets, and peer support should beconsidered. Employer needs to consider also thatstress lessens production and performance.

f

f

f

f

Introduction
In today’s work life, employees are working for
longer hours, as the rising levels of responsibilities
require them to exert themselves even morestrenuously to meet rising expectations about work
performance. Occupational stress is the adverse
psychological and physical reactions that occur in an
individual because of their being unable to cope withthe demands being made on them. Moreover, work
related stress has been a topic that has received
increasing attention, in occupational health, over thelast three decades. These authors believed the world,
especially the world of work and business, has
become increasingly subject to fast changing forces131

like increased competition, the pressure of quality,
innovation and an increase in the pace of doing
business. The demands on employees grew equally
dramatically and this created stress within
employees. Apart from stress that arose from thework situation, other sources of stress could relate
to personal factors such as relationships with others
and use of free time.
Ongori and Agolla (2008) mentioned that The
International Labor Organization (ILO) reported that
inef iciencies arising from occupational stress may
cost up to 10 percent of a country’s GNP.
Occupational stress includes perceived loss of job,and security, sitting for long periods of time or heavy
lifting, lack of safety, complexity of repetitivenessand lack of autonomy in the job. In addition,
occupational stress is caused by lack of resourcesand equipment; work schedules (such as working
late shifts or overtime) and organizational climate
are considered as contributors to employee’s stress.
Occupational stress often shows high dissatisfaction
among the employees, job mobility, burnout, poor
work performance and less effective interpersonal
relations at work.
In the United States, the number of stress claims
has trebled in the last year with 15 percent of all
workers compensation claims being for stress. The
cost to organizations of this level of occupational
stress lies anywhere between 200 and 300 billion
dollars per year because of high staff turnover,increased health and workers’ compensation claims
and decreased productivity (Kendall, Murphy,
O’Neill, & Bursnall, 2000). In addition, recent igures
emanating from Britain have indicated that 70,000
workers are absent from work due to occupational
stress every year (Kendall & Muenchberger, 2009),
costing the nation around seven billion pounds inlost productivity, worker entitlements and healthcare. A subsequent result of these factors is the lossof 40 million working days per year (Shergold,
1995). Stress is a universal element experienced by
employees around the globe. Stress has become
major problem for employer particularly indeveloping nations where the employer doesn’t
realize the impact of stress on employee
performance which ultimately results in criticalmanagerial dilemmas. Giga and Hoel (2003)
concluded that high rates of mergers, acquisitions,increasing economic interdependence among
countries due to globalization, technologicaldevelopment, and restructuring have changed theorganizational work over the last few decades andhave resulted in time pressure, excessive work
demand, role con licts, ergonomic insuf iciencies andproblematic customer relationship which are causesof stress.
In the Philippine settings, health problems
among supervisors in manufacturing industries areassociated with occupational stress. Work amongsupervisors was reported to be challenging andstimulating but regular upgrading of skills wasneeded. Based on the personal interviews conducted132

Eubios Journal of Asian and International Bioethics 32(5) (September 2022)

among the supervisors, the issues in the workplace
included information overload, keeping abreast with
developments in their ields of expertise, the need to
be multi skilled, stress brought about by information
technology, the new pedagogy in the workplace
affecting occupational stress, stringent computerbased supervisory monitoring, and the need for neworganizational strategies. Lu and Prokopenko (2012)
mentioned that occupational stress amongsupervisors was found to be signi icantly associatedwith heavy load stress, mental requirements ofwork, massive technical/of ice work, and the use of
microelectronics equipment needing concentrationand literacy in it, and regular upgrading of skills.
In the local setting, developing research
environment was still evident speci ically in the
Department of Public Works and Highways. Thus, noresearch information was retrieved about the
conduct of the same nature of the study within thelocale. As to need to do the research, the of ice is notexempted with stressful situations: rendering
overtime (extended time to 9 PM during regulardays, weekends and holidays) specially during lastsemester after the release of National Expenditure
Program (NEP) just to cope up with the deadlines in
preparation of Preliminary Detailed Engineering(PDE); requiring all projects to be bid out in themonths of November and December in the case ofdesign engineers of the Planning and Design Section;
to cope up the expiration date as indicated thecontract in the case of Project Engineers andMaterials Engineers in Construction Section,
Maintenance and Quality Assurance Section, and thelikes. The mandate of the of ice has been made clear
and ensured to be in utmost transparency, heralding
the Department to shun corruption practices andimprove its ef iciency.
With high regards to this context based on the
global phenomenon on occupational stress which
effect was determined and was known to both global
and international, this study was conducted to
examine the situations that may in luence theoccupational stress and its role to the productivity of
the Department of Public Works and Highways(DPWH) employees in Davao del Sur District
Engineering Of ice.
Objectives of the study
This study aimed to identify the occupational stressexperiences of civil engineers in the Davao del Sur
District Engineering Of ice in the implementation ofroad construction projects. More speci ically, thisstudy aimed to determine the effects of this
occupational stress in the effective function ofproject implementation in the district; and to
explore the coping mechanisms of civil engineers tokeep abreast of their functions despite occupational
stress.

f

f

f

f

f

f

f

f

f

f

f

f

f

f

f

f

f

f

Signi icance of the study
This study would be bene icial to the civil engineers
who play the role of project implementers andsupervisors in road construction projects. This
would provide enlightenment to a perspective
nature of occupational stress at work and the factorsthat might explain why these happen. Thus, it would
help improve the leadership and management ofvarious public works and highways of ices based on
the identi ied probable factors as basis for policy
revisit and institutional development. This study isalso important for policy analysts, particularly thoseworking for the government under the helm of Civil
Service Commission to look on the stories of project
implementers relative to encountered occupational
stress in doing their job. This could be a valuable
input in establishing programs relative to addressing
occupational stress, which is correlated to red tape,declining productivity, and low engagement.
Scope and limitation of the study
This study was focused on the occupational stressexperiences of the civil engineers who are in charged
on the implementation of road networking projects
in Davao del Sur. It also touched the perceived effectsof these sources of occupational stress as well as theconsequent coping mechanism to do away with thestringent effects of stress at work. The focus was on
the project implementers: Design Engineers, Project
Engineers, and Materials Engineers of the chosen
public works and highways of ices. The focus was todraw out the experiences of these personnel througha qualitative approach.
Methodology
This study made use of a qualitative method and was
exploratory in nature; thus, any facets of information
derived were all luid, subjective, and given from theperspective of the participants and based upon theirunderstanding. Jackson, Drummond, and Camara(2007) mentioned that qualitative method is
primarily used to understand human beings’
experiences in a humanistic approach. Bontuyan,
Luspo, Salazar, and San Jose (2013) on the other
hand said that qualitative method is used to describe‘the struggle and triumphs’ of individuals in their
day-to-day encounter; likewise, San Jose, Bahket andAlsalhi (2017) averred that it used to reveal personal
experiences and insights. Thus, qualitative method isappropriate to this study because it focused on theindividual and collective experiences of the civilengineers. Personal accounts on struggles andtriumphs in the jobs were also considered.
This study was conducted in order to gain
understanding of the occupational stressexperienced by project implementers andsupervisors through their day-to-day experiences atwork. The qualitative research explored anddescribed how these experiences affect their work,
their personal life, and the dynamics at work under
the helm of Civil Service Commission rules andregulations. The research technique used was amodi ied Van Kaam method (Anderson & Eppard,1998) based upon recorded and transcribedinterviews using in-depth interview questions tocapture the day-to-day experiences of civilengineers.
Sources of data
The target participants of this study were the 12 civilengineers from the Davao del Sur District
Engineering Of ice. There were four supervisors,four project engineers, three design engineers, andone materials engineer who served as participants ofthe study. These personnel were assigned in the
Planning and Design Section, Construction Section,
Quality Assurance Section, and Maintenance Section.
Samples of potential participants represent thetarget population of interest, with the samplingframe comprised of the population from which thesample was drawn (Neuman & Kreuger, 2003). The
informants were purposefully and conveniently
chosen so that the information needed to expedite
the study would be the exact data necessary toanswer the research questions posted in the earlier
part of this paper. Convenient sampling was used ingetting the 12 informants. A focus group discussion
involving the same number of different participants
was conducted to draw coherence on the individualinterviews. Creswell and Creswell (2017) addressed
the issue of the appropriate number of participantsin qualitative research participants expected toprovide thematic saturation of the experiences.
However, San Jose (2012) pointed out that due to thelimited number of the participants, the indings ofthe study cannot generalize the entire instead results
can only be applicable to the involved participants.
Research locale
This study was conducted in DPWH Davao del Sur
Engineering District which composed of four (4)sections directly involved in project implementation
namely: Planning and Design, Construction, Quality
Assurance, and Maintenance section.

f

f

f

f

f

f

f

f

f

f

Data gathering procedure
Many factors were involved in the consideration of
appropriate research methods for data collection
and instrumentation (Anderson, 2003). The factors
include the need for data from subject matter
experts based upon the day-to-day experiences andvaried perspectives from diverse participants.
Creswell, Plano-Clark, Gutmann, Hanson (2003)
identi ied observations, interviews, documents, andaudio-visual materials as forms of data collection.
The use of unstructured observational data in
different venues as a participant observer or nonparticipant observer is not available and precludes
the opportunity to take ield notes or to record data
to inform the research. Elliott (2005) mentioned thatthe most appropriate and available data collection
method to achieve data validity and reliability in thetarget population frame is the in-depth interview.
In this study, face-to-face interview using semistructured questions was used to provide the mostappropriate instrument to understand the central
phenomenon of occupational stress in theffEubios Journal of Asian and International Bioethics 32(5) (September 2022)

133

p e r s p e c t ive o f p ro j e c t i m p l e m e n te r s a n d
supervisors. Further, a focus group discussion wasorganized, which added some cooperating
personnel, contractors and some project inspectors,
in order to corroborate the qualitative data analysis
on the in-depth interviews. The focus group
discussion served as a way to triangulate theanalysis so that other factors would surface, whichgave weight or credence to the statements of theparticipants in the prior in-depth interview. Finally,
the researcher also observed non-verbal forms ofcommunication such as gesture, reaction ormannerisms exhibited in face-to-face personal
interviews to provide additional insight in theanalysis.
Data analysis
In the analysis of data, the constant comparison
technique of was utilized which draws on threeessential steps: data reduction, data display, andconclusion drawing and veri ication. During the data
reduction, interview answers of the informants fromthe audiotape were transcribed and translated, andwere decided on how to code, group and organize
categories. During the data display, the researcher
presented them in a form of a igure illustrating thepatterns and indings of data. During the conclusion
drawing and veri ication, initial thoughts about
patterns were developed.
The analysis of qualitative data is exploratory innature and employs a constant comparison
procedure (Anfara, Brown, & Mangione, 2002). Allinterviews were transcribed and analyzed as they
were collected. Initially, transcripts were read andre-read, and notes were taken as broad themes orconcepts emerged. Subsets of concepts called
categories were noted and gradually fell into thecontext of the broader themes.
Results and discussion
After conducting in-depth interviews withinformants that resulted in several pages oftranscribed texts, formal analysis of the data began.
It started with becoming familiar with thetranscribed data from the audiotape. The transcripts
were then translated into English language making it
sure that the thoughts still preserved the same fromthe transcript. In addition, the process also entailed
making several decisions about which data it
together and were therefore useful for the study, andwhich data would have to remain unused for thisstudy because they were unrelated to the threeresearch questions. Strict focus to the purpose of thisstudy, the expertise of the panel members, and theauthority of the researcher. In the analysis of thedata, three steps were employed. There were data
reduction, data display, and conclusion drawing andveri ication. In the data reduction phase, answers of
the interviews were transcribed and translated,
coded, grouped and organized. In the data display,indings were presented in igure form. During theEubios Journal of Asian and International Bioethics 32(5) (September 2022)

conclusion drawing and veri ication, initial thoughts
about patterns were developed.
The data were presented in igures patterned
after the study of Gempes (2008). Broad themes arelabeled as “root codes”. Similar responses wereshortened and grouped into branches. The branch
codes were further categorized into roots. The
presentation was done by counting the number of
responses per branch code and summing up them intheir respective main theme or root codes. The sum
was expressed in percentage based on the total
number of responses, not numbers and de initely
not averages.
Branch Codes Root Codes

Figure 1: Occupational stress-related experiences* Does not sum to 100% due to existence of variant
themes.

Figure 1 reveals that among the informants’
responses to research question number one, 46.16%
was stress-related experiences on the Department’s
mandated targets, which included accomplishmentof reports and the preparation of Preliminary
Detailed Engineering activities specially after the listof projects included in the National Expenditure
Program (NEP) was released, coordination between
DPWH and recipients of projects, and regularmonitoring of Region and Central Of ice. According
to InformantVO2136 when asked about what usuallycaused stress her in doing her function at DPWH, sherecalled:
We submit accomplishment report every month.
In the site, the contractor won’t submit theirevaluation report because of unfavorable
circumstances. During the project, there weremany important things not considered likeroads, curing of the roads. Time constraints us.
We have so many accomplishment reports tosubmit (Archive VO2136-11-0236).

f

f

f

f

f

f

In like manner, similar experienced was shared byInformant ML3325, when I asked the same question.
She said:
It’s not stressful for me, but there are certain
cases that it is indeed stressful. As far as Davaodel Sur Engineering Of ice is concerned, it’s not

f

f

134

actually a stressful place to work. However,there are times that we are really trying toreach the target even if time is running out.
When we try to accomplish these deadlines,
especially if projects are expected to be
implemented as they are reported, this causes
stress to us implementers (Archive
ML3325-05-0404).
Moreover, 38.88% of the informants’ responses
focus on stress experiences centered on contractors,
which included unmet standards by contractors,
quality of materials used by contractors, andperformance evaluation of contractors. This wasparallel to the statement of Informant RO3941 whena sked a b ou t hi s ex p eri en c e on p rob l em s
encountered in implementing the project:
In my department, we have these several
contractors that are quite lagging in
implementing the project, and if we do followups, there are instances that they cannot deliverit right away. It’s quite a burden for us in the
Department. It might be because they cannot
procure the appropriate materials. But we haveno choice but to do follow-up even if we startlate in the project (Archive RO3941-08-0133).
In like manner, similar experienced was shared byInformant DC0813, when I asked the same question.
She said:
What makes us stressed as an engineer is when
the project is bid, the one contractor that wins
(because of the several projects that they have),sometimes, they cannot meet the duration of the
project. The project has ended, but the project is
not even accomplished. We are stressed because
we have targets to accomplish by week ormonthly (Archive DC0813-03-0108).
Moreover, the statement of Informant AB4441
revealed the same inding based on the interview
when she was asked about her experience on
problems encountered with contractors in
implementing the project:
What I can about stress as a project engineer isirst, when the project is bid and since we are
the implementer, there are times that thecontractor cannot start because they handled a
lot of projects. The contractor does
simultaneous work because time is runningevery now and then. Since they are given limited
time to inish the project, we are worriedbecause we have accomplishments to ensure
every week, quincenal and monthly incompliance to Quality Assurance and Control.
(Archive AB4441-02-0126).

Eubios Journal of Asian and International Bioethics 32(5) (September 2022)
Figure 2. Effects of occupational stress to the effectivefunction of project implementation

Root Codes

Branch Codes

Effects of OccupationalStress of theEffective Function* Does not sum to 100% due to existence of variant
themes.

Figure 2 shows that among the informants’
responses to research question number two, 50.07%
was stress-related effects on work performance,
manifested in beating the deadlines set by Central
Of ice, lots of projects implemented by same
contractors, and compliance to new directives
implemented by Central Of ice. According toInformant AB4441 when asked about the impact ofoccupational stress in her work, she mentioned:
The contractor that does not meet his/hercommitment with the project affects theperformance of the project engineer. When thecontractor is lagging behind, that means we are
not also effective in doing our job (Archive
AB4441-02-0700).
In the same vain, Informant WA7740, when asked
the same question. He said:
Planning is stressful because of multitasking.
For example, as a designer for instance of roads,
when you are doing program (in design) withlimited time frame for you to accomplish, you
become stressful when a new task is inserted for
you to work and be rushed to be accomplished.
That is quite stressful (Archive
WA7740-12-0339).

f

f

f

f

f

f

f

f

Moreover, 32.58% of the informants’ responses
focus on the effect of stress on personal mood andemotions, which was manifested in relief con lictwith end bene iciaries in the implementation ofprojects, exasperation due to unmet deadlines
affecting quincenal report, and frustration on people
seeing DPWH in bad image. This was parallel to thestatement of Informant ML3325 when asked about
her experience on how stress caused her
performance, she narrated:
The lack of resources in DPWH, like the service(vehicles) that are vintage (worn out) becauseof lack of budget for that, hinders our
implementation. We also lack manpower
because of the volume of work. An employee
possibly become inef icient because of two or
three times the normal of work volume. Plus, theISO preparations! We need to in a hurry(Archive ML3325-05-1156).

135

Likewise, similar experienced was shared byInformant DC0813, when I asked the same question.
She said:
Sometimes, there are con licts in the plans thatare not addressed, especially right of way; there
are structures and plants that are not resolvedin the planning phase. Because of this, we might
be met with resistance from the people in thecommunity (Archive DC0813-03-0401).
Moreover, the statement of Informant RS1165
revealed the same inding based on the interview
when asked about her experience on how she felt
when encountering stressful situations in
implementing the project, she shared:
Based on my experience, I sometimes handle
projects with “honest” contractors, having
personnel that are hard-headed. They reallycause me stress. Another one is some situation
where contractors, engineers or foreman andeven laborers who do not follow regulations andte n d to d o i l l i c i t a c t i v i t i e s ( A rc h ive
RS1165-07-0110).
Figure 3. Coping Mechanisms
Root Codes

Branch Codes

Coping mechanisms* Does not sum to 100% due to existence of variant
themes.

Figure 3 showed that among the informants’
responses to research question number three,34.57% considered stress as a normal state at work,
which was manifested in terms of mind conditioningor acceptance, emotions management, and re lection
and prayers. According to Informant JJ0264 when
asked about how she was coping with stress at work,
she narrated:
I do constant follow-up to fast-track theimplementation of the projects. If there areproblems, we should not fail in informing ourcontractors and engineers so that they are given
due attention. For me, this is a way of
decongesting stress build-up because I
personally address this by making theminformed. (Archive JJ0264-04-1310).
Similarly, Informant AC2005 shared her experiences
when asked the same question. She said:

136

Eubios Journal of Asian and International Bioethics 32(5) (September 2022)

Stress is normal in every work. In my case, I am
happy that my team cooperates in solving
certain problematic situations. Each of themhas a share in the resolution of challenges at theworkplace (Archive AC2005-01-0939).
Moreover, 29.96% of the informants’ responses
focused on effective feedback at work, which was
manifested in direct confrontation, reporting tohigher authorities, and understanding colleagues.
This was parallel to the statement of Informant
TR3063 when asked about how she handled stress,
she narrated:
In my situation, I talk and exchange ideas withpersonnel regarding the challenges andproblems that we encounter in the workplace. I
also raise concerns to direct supervisor becauseof bureaucracy in the of ice. You cannot justenter in the of ice of your boss (Archive
TR3063-10-1218).
In like manner, similar experienced was shared byInformant ML3325, when asked the same question.
She said:
Communication. When there are problems, it’sbetter to talk with it. You also need unwinding,relaxing and team-building. Summing it all,communication is the key. You might not work
harmoniously if you do not communicate
effectively and understand your differences(Archive ML3325-05-2401).
Lastly, 26.34% of the informants’ responses focusedon the role of family in distressing from stressbrought by work, which was manifested in terms ofsharing experiences to family member andrelaxation and outing. This was parallel to thestatement of Informant RS1165 when asked about
how she handled stress, she narrated the role of his
family:When I arrive home, I share this to my spouse sothat I can unload my feelings. I share thisbecause I do not really argue with mycolleagues. My spouse listening to my concerns
in the of ice is quite a stress-reliever. (Archive
RS1165-07-1353).
Similarly, Informant VO1876 shared herexperience I asked the same question. She
said:
Stress at work is permanently happening atwork. Just make sure that the stress at work
should not affect your relationship with yourfamily. Anyway, they are the reason why you areworking right? (Archive VO1876-11-1027).

f

f

f

f

f

f

f

f

f

f

Conclusion
Based on the results of this study, the researchers
opted to point out several remarks. These are thefollowing: occupational stress can occur when there
is a mismatch between the requirements of the role,capabilities and resources and supports available.
Everyone knows what stress feels like but while thisstress is normal, if it is ongoing, it can become aproblem. While the places we work come in all
shapes and sizes, mentally healthy working
environments can help in addressing occupational
stress experienced by project implementers.
Moreover, positive workplace culture is contributory
in attaining a good place to work. People feel goodabout coming to work, and everyone is encouraged
and supported in the function of their work. Anotherrealization of the researcher is that stress can be
managed. Stress, heavy workloads, unrealistic
deadlines, poor communication, uncertainty – theseand other factors can all contribute to anxiety atwork, and it is up to project managers to keep themin check. Moreover, the power of support bystakeholders to the vital contribution of DPWH tothe community will bring about ease for the project
implementers to do their job. Finally, as regards tothis study, the researcher could say that occupational
stress experienced by project implementers andsupervisors in the case of Davao del Sur District
Engineering Of ice is a case worthy of re lection. The
problems encountered by project implementers may
or may not re lect the experiences by other District
Engineering Of ice in the Region or in the country atlarge. With the implications presented, occupational
stress as experienced by project implementers andsupervisors may be lessened, if not eradicated.
Implications
Stress has been shown to be present in all
professions (Olson & Swenson, 2011), and is
ubiquitous throughout the phases of theperformance of work or task (Glass, Kasl, &Berkman, 1997). Occupational stresses often leadproject managers and implementers to rely on
overtime as a tactic to meet project mileposts anddeadlines. With this, the aim of this study was to
identify the occupational stress experiences and thecoping mechanisms of project implementers andsupervisors in the case of Davao del Sur District
Engineering Of ice. The researcher had done indepth interviews and data analysis on the responses
from 12 informants. The insights gained from theinformants in this study and the review of theliterature plays a major role in the work
performance and effective functioning of project
implementers and supervisors dealing withoccupational stress and their coping mechanisms.
Working excessive or mandatory overtime is not
only disruptive for the project implementer but also
for the implementer’s family and social life (Hill,
Hawkins, Ferris, & Weitzman, 2001). When thetransitions between work and home become
disrupted, people tend to overlap work and homefunctions that lead to more stressful and lessef icient multitasking (Floro& Miles, 2003). Suchs c h e d u l e s c a n a dve r s e ly a f fe c t a p ro j e c t
implementer’s time with his/her family, create rolecon licts, work overload, and miscommunication(Crouter, Bumpus, Maguire, & McHale, 1999). To
address this, improved scheduling andcommunication with contractors with regards toEubios Journal of Asian and International Bioethics 32(5) (September 2022)
project implementation and expectations can beestablished through the proper implementation ofproject management (Shigaki, Glass, & Schopp,2006). Effective management of the project
expectations and deliverables helps an organization
like DPWH to avoid having projects passed tocontractors who are fond of overlapping many
projects at one time such that a bind on one willaffect performance on the others. Nonetheless, it is agiven that the best plans will often show laws inlater development (Arora, Aggarwal, Moran,
Sirimanna, Crochet, Darzi, & Sevdalis, 2011).
Occupational stress can also be reduced byrealizing that people in the workplace are alsostressed, and that poor communication happens in
between. Shigaki et al. (2006) suggested that muchproject completion occurs at the wrong time and isoften done by the wrong people. He further
considered that project implementers andsupervisors do not communicate with the people
around as clearly as they want to. It also highlights
the need to involve project implementers who havestronger interpersonal needs and skills, so they cancommunicate what they need and provide more
effective support to each other.
The above-mentioned implications may be ofgreat help for project implementers and supervisors
in the context of DPWH Davao del Sur District
Engineering Of ice. The above-stated measures may
somehow eradicate the imbalance between projectcompletion as expected by project implementers of
DPWH and the occupational stress of suchexpectations bringing them.
Competing interests
The was no competing interest exist in the conductof this study.
Ethical approval
To address the research ethics, the researchers
followed the strict protocols for con identiality of theparticipants’ identity and the information gathered.
Consent letters were given to the participants toseek for their permissions before the conduct of theinterviews. The aim and objectives, length of theinterviews, and withdrawal clause were alsopresented. Interviews were conducted in a mostconducive place to provide ample privacy, little
destructions, and comfortable environment to theparticipants. The participants were assured that therecorded interviews were kept by the researchers
for safe-keeping and would be destroyed after two
years. The information obtained were used forresearch purposes only.
References

f

f

f

f

f

f

f

f

1. Anderson N. (2003). Applicant and recruiter reactions
to new technology in selection: A critical review andagenda for future research. International Journal of
Selection and Assessment, 11(2-3), 121-136.
2. Anderson J, Eppard J. (1998). Van Kaam's method
revisited. Qualitative Health Research, 8(3), 399-403.

137

3. AnfaraJr VA, Brown KM, Mangione TL. (2002).
Qualitative analysis on stage: Making the research
process more public. Educational researcher, 31(7),28-38.
4. Arora S, Aggarwal R, Moran A, Sirimanna P, Crochet P,
Darzi A, Sevdalis N. (2011). Mental practice: effective
stress management training for novice
surgeons. Journal of the American College ofSurgeons, 212(2), 225-233.
5. Bontuyan Jr JB, Luspo AMB, Salazar MS, & San Jose AE.
(2013). Dif iculties and triumphs in learning a target
language: Indigenous students in focus Ariel E. San
Jose. Natura, 17(12).
6. Creswell J W, Creswell J D. Research design: Qualitative,
quantitative, and mixed method approaches. Sage
publications. 2017.
7. Creswell J W, Plano Clark VL, Gutmann ML, Hanson
WE. Advanced mixed methods research
designs. Handbook of mixed methods in social andbehavioral research, 209, 2003; 240.
8. Crouter AC, Bumpus MF, Maguire MC, McHale SM.
Linking parents' work pressure and adolescents' wellbeing: Insights into dynamics in dual earnerfamilies. Developmental Psychology, 35(6), 1999; 1453.
9. Elliott J. Using narrative in social research: Qualitativeand quantitative approaches. Sage Publications. 2005.
10. Floro MS, Miles M. Time use, work and overlapping
activities: evidence from Australia. Cambridge Journalof Economics, 27(6), 2003; 881-904.
11. Gempes GP. Locus of control and work commitment ofbaby boomers and generation X. Liceo Journal ofHigher Education Research, 5(2), 2008. 104-118.
12. Giga IS, Hoel H. Violence and stress at work in inancial
services. 2003.
13. Glass TA, Kasl SV, Berkman LF. Stressful life events anddepressive symptoms among the elderly: Evidence
from a prospective community study. Journal of Agingand Health, 9(1), 1997; 70-89.
14. Hill EJ, Hawkins AJ, Ferris M, Weitzman M. Finding an
extra day a week: The positive in luence of perceived
job lexibility on work and family life balance. Family
relations, 50(1), 2001; 49-58.
15. Jackson RL, Drummond DK, Camara S. What isqualitative research? Qualitative research reports incommunication, 8(1), 2007; 21-28.
16. Lu JL, Prokopenko J. Improving public services
productivity: Problems and challenges. Geneva:
International Labour Of ice, 21-23. 2012.
17. Kendall E, Muenchberger H. Stressors and supports
across work and non-work domains: The impact onmental health and the workplace. Work, 32(1), 2009;27-37.
18. Kendall E, Murphy P, O’Neill V, Bursnall S. Occupational
stress: Factors that contribute to its occurrence andeffective management. 2000.
19. Neuman WL, Kreuger L. Social work research methods:
Qualitative and quantitative approaches. Allyn andBacon. 2003.
20. Olson B, Swenson D. Overtime effects on project teameffectiveness. In The Midwest Instruction andComputing Symposium. 2011.

Eubios Journal of Asian and International Bioethics 32(5) (September 2022)

21. Ongori H, Agolla JE. Occupational stress inorganizations and its effects on organizational
performance. Journal of management research, 8(3),2008; 123-135.
22. San Jose AE. Linguistic experiences of adult dyslexic
learners. UIC Research Journal, 18(1), 2012;1-1.
23. San Jose AE, Bahket R, Alsalhi HHA. Teach us the way
we want: Teaching approach for special needs
students. European Journal of Special Education
Research. 2017.
24. Shergold JH. (1995). Timescales 1. Cambrian. AGSO
Record, 30(1995), 1-32.
25. Shigaki CL, Glass B, Schopp LH. Mindfulness-based
stress reduction in medical settings. Journal of ClinicalPsychology in Medical Settings, 13(3). 2006; 209-216.

Tri-people Hybrid Conflict
Resolution Approach: Enabling A
Culture of Peace in Alamada, North
Cotabato, Philippines- Asst. Prof. Mark Anthony N. Lataza, MA
Pamantasan ng Lungsod ng Pasig (University of
Pasig City); University of Santo Tomas, thePhilippines
marklataza@gmail.com- Hon. Bartolome B. Lataza, Jr.
Municipal Councilor, Alamada, Cotabato, thePhilippinesbart.jr02@gmail.com
Abstract
This paper is focused on the Tri-people hybrid
con lict resolution approach adopted in Alamada,North Cotabato as a model for enabling a culture ofpeace in Mindanao, Philippines. Alamada is amunicipality of North Cotabato, Mindanao. The
population is comprised of Iranon (Muslims),
Christians, and other indigenous/ethnic groups(Lumad). The greatest challenge encountered waspeace instability resulting from territorial andancestral land disputes; identity and cultural
discrimination; environmental threats, criminality,and poverty.
Peace instability is an armed con lict that causes
the animosity brought about by the history ofighting in Mindanao. Land dispute is a con lict inAlamada but it could spill over to rido and armed
con lict. Rido/clan con lict is a Muslim term forfeuds, referred to as a sporadic outburst ofretaliatory violence between families and kinshipgroups as well as between communities andenvironmental issues.

f

f

f

f

f

f

f

f

f

To address the societal con lict and strengthen
the alliances of "Tri-people", peace-building
practices are essential. This is to effectively settle
longtime issues and constitute best practices among
the community from a con lict-torn to a zone of

f

f

138

peace municipality. By combining the informal
customary procedures of the Muslim people and theIndigenous community, settling gaps within thecommunity is more effective.
As result, there were at least 18 clan con licts thatwere settled under the approach, including one clan
con lict in the municipality which has beenpreserved for 50 years. The effective implementationof the reconciliation mechanism is limited in the
declaration of the Zone of Peace in Alamada. The
government and its local partner gathered morethan 10,000 signatures from various consultations
and discussions in the municipality to gather
support for the declaration. Peacebuilding should bea mechanism converged with public service to craft asensitive and hybrid initiative to address societal
problems. There is a need to intensify and concretize
an effective tool to promote a culture of peace as an
ethical solution to a culture of violence.
Keywords: Alamada, Alternative Dispute Resolution(ADR), Culture of Peace, Culture of Violence, Loveand Tri-people.
Since wars begin in the minds of men,
it is in the minds of men than defences of peacemust be constructed.
- UNESCO Charter, 1945
Introduction
Kalilintad, Kalinaw, Kapayapan, Peace – these aredifferent words but it is a vision that everyone
aspires for (EED, 2012, Prologue). Peace is a vision
to which we all aspire. This is also an ancient desireof the distant past. Even modern peacebuilders andtheorists take different positions in analyzing oursocial processes which could cultivate peace. Peacehas been thought about, talked about, and studied inmany ways and in many aspects. Peace is a dream ofevery person. This is also the dream of Alamadians
to live peacefully and productively. The actualizationof this culture of peace will rede ine each person
toward progressive life.
This peace is a God-given peace that our creator
desires for us, and to which life simply calls us, isbuilt on justice, where everything and everyone in
the created order is in the right relationship witheach other and can reach their God-given potential.
Each person must be envisioned as or God-Centeredperson empowered, prosperous, and living in love,justice, and peace. This argument of Vatican II canalso be seen in Albert Einstein's "Peace is not merely
the absence of war but it is the presence of justice, oflaw, of order—in short, of government" (1968, p.
371). This is also substantiated by the fact that
Vatican II implicitly expresses it by stating that
"Peace is not merely the absence of war; nor can it
be reduced solely to the maintenance of a balance ofpower between enemies; nor is it brought about by
dictatorship. Instead, it is rightly and appropriately
called an enterprise of justice" (Gaudium Et Spes,
1965). Justice is conceived in both abstract andconcrete forms. In its abstract form, justice isthought of as peace, equality, and unity of people.
Likewise, Betita supported this and said "There canbe no justice if there is no peace" (Betita, V., et al.,2014, p. 34). While Fromm also highlighted and said,"The condition of peace is not only the absence ofviolence rather peace is the full humanization ofindividuals through full relationships with otherhuman beings and relationships with nature" (2011,p. 4). This simply means that the government shouldbe the one promoting justice by implementing thelaw and protecting the society from fragile
exhaustion that exists in the aftermath of con lictwhen lives have been torn apart, relationships
broken, infrastructures destroyed, and homes
demolished.
Therefore, the culture of peace is not merely theabsence of war but it is a peace that is geared toward
the person's quality of moral decisions, and to beholistic it has to be grounded on the core value of theperson. Real peace needs to be worked at, as a lifelong relationship. It is built by those who direct theirefforts to its establishment, day after day. Its pursuit
means listening to the voice of the oppressed andbeing challenged to action. It means seeing all
humanity as our brothers and sisters and honoringother people's development, as well as our own. Itmeans building a future for the next generations sothey can know life in all its fullness and peace in its
entirety.

f

f

f

f

f

f

f

f

f

f

f

f

f

f

f

f

f

f

f

f

f

f

f

f

f

Culture of Peace
It was in 1989, during the International Congress on
Peace in the Minds of Men, in Yamoussoukro, Côte
d'Ivoire, that the notion of a "Culture of Peace" wasirst mentioned. Over the past ten years, the idea hascome a long way. In 1994, Federico Mayor, DirectorGeneral of the United Nations Educational, Scienti ic
and Cultural Organization (UNESCO), launched aninternational appeal on the establishment of a rightto peace; in February 1994, UNESCO launched it's
Towards a Culture of Peace program; in 1997, theUnited Nations General Assembly proclaimed theyear 2000 as the "International Year for the Cultureof Peace"; and in 1998, the same Assembly declared
the period 2001-2010 the "International Decade fora Culture of Peace and Non-Violence for the Childrenof the World"(Adams, D., 2005).
The expression "Culture of Peace" took shape in
1989, such a culture already existed before the word
was created. UNESCO's creation is a testimonial tothe existence of such a culture as early as 1945. The
culture of peace was irst analyzed by United Nations
as a "set of values, attitudes, modes of behavior andways of life that reject violence and prevent con licts
by tackling their root causes to solve problems
through dialogue and negotiation among individuals
groups and nations." The notion of a "Culture ofPeace" was irst mentioned during the International
Congress on Peace in the Minds of Men, putting thismandate into practice (1989). It stated: "Peace isreverence for life. Peace is the most preciousff

Eubios Journal of Asian and International Bioethics 32(5) (September 2022)

139

possession of humanity. Peace is more than the endof armed con lict. Peace is a mode of behavior. Peace
is a deep-rooted commitment to the principles ofliberty, justice, equality, and solidarity among all
human beings. Peace is also a harmonious
partnership of humankind with the environment(Mayor, 2011, p. 10).
This was supported by Boulding, the main point
about the Culture of Peace is that it deals creatively
with difference and con lict, and it is a listening
culture. The culture of peace needs lots of space forproblem-solving. So, what we need to do is create alot of space for problem-solving. I believed that theculture of peace is building a society centered onhuman creativity and productivity. This is how thenotion of a culture of peace conquered the world.
Fromm asserts that it is one of our human ideals
without which we become insane (1956, p. 28).
Same as in the Philippines especially in
Mindanao, the culture of peace was adopted with thesame framework of sustainable peace consisting ofvalues, attitudes, and behaviors. It re lects andinspires social interaction and sharing based on theprinciples of freedom, justice, democracy, humanrights, tolerance, and solidary. It further rejects
violence, endeavors to prevent con lict by tackling
the root causes of the problems through dialogue
and negotiation, and guarantees the full exercise of
all rights and the means to participate fully in thedevelopment processes of the society (EED, 2012, p.
43). However, the culture of violence is also present
that hampered the culture of peace.
Culture of Violence
Since we need to understand the culture of peace, weneed also to differentiate it from the culture ofviolence. These are visible and invisible con licts.
Visible con licts are physical assault, killing, stealingharassment, war, terrorism, etc., while invisible
con lict is hatred, misunderstanding unbalanced,
judgment, human rights, violation, polarization, etc.
This visible and invisible con lict is present
everywhere even in each person, in the family,community, and society (Act for Peace Programme,
2006, pp 1-2).
There are four dimensions or levels of con lict that
we need to consider and these are Personal
Dimension (Intra-personal con lict), Inter-Personal
Dimension (con lict with other people), Structural
Dimension (Intra-group con lict/Intraorganizational), and Cultural-Religious Dimension(con lict with other people). Personal Dimension(Intra-personal con lict) refers to con licts occurring
within a person. Usually, people need to work on
their inner struggles and issues to be constructive insocial con licts. Ex. Sel ishness, greed, trauma, lack ofself-con idence, and sinfulness. Inter-Personal
Dimension (con lict with other people) refers to
con licts occurring between individuals or a small
group of people. One should overcome any con licts
between themselves before negotiating broader

140

Eubios Journal of Asian and International Bioethics 32(5) (September 2022)

f

f

f

f

f

f

f

f

f

f

f

f

f

f

f

f

f

f

f

f

social change. Ex. biases, prejudices, stereotyping,trash talk. Structural Dimension (Intra-groupcon lict/Intra-organizational) Refers to thosecon licts that happen within a particular group,
whether it is a religious, ethnic, political, or othertype of an identity group. It is important to be able tomanage the con licts within your group and be able
to communicate with others within your group tobuild support for the long-term process. Ex. poverty,
injustice, oppression, inequality, corruption.
Cultural-Religious Dimension (con lict with otherpeople) refers to con licts occurring between largeorganized social or identity groups. To be successful
peacebuilders we need to have the skills to work
both within our groups as well as between groups(Ibid, p. 15).
Even Fromm claims that the concept of violence isrooted in hate and destructiveness" (2004, pp.
43-48). Fromm added that "hate and destructivenessare impulses which obscure rational and objective
thinking and easily create polarization in that they
reinforce each other on both sides of the political
spectrum. The main problem with the idea that
aggressiveness is an instinct charged with aspontaneously increasing energy lies in theextraordinary variability of aggressiveness amongindividuals and societies" (Ibid). This validates
further Hobbes's reaction to the ambivalence ofmodernity which asserts that injustic e, ingratitude,
arrogance, pride, iniquity, and the rest can never bemade lawful it can never be that war shall preserve
life, and peace destroys it (1951, p. 121). Slavoj Zizek
sustained this violence. According to Zizek, "there is
subjective and objective violence which cannot beperceived from the same standpoint: subjective
violence is experienced as such against thebackground of a non-violent zero level. It is seen as aperturbation of the "normal," peaceful state ofthings. However, objective violence is precisely theviolence inherent to this "normal" state of things.
Objective violence is invisible since it sustains thevery zero-level standard against perceiving
something as subjectively violent. Thus, systemic
violence is something like the notorious "darkmatter" of physics, the counterpart to all-too-visible
subjective violence. It may be invisible, but it has tobe considered if one makes sense of what otherwise
seems to be "irrational" explosions of subjective
violence" (2008, p. 2).
Mindanao is known for peace instability such as
armed con lict (because of the animosity brought
about by the history of ighting in Mindanao);territorial and ancestral land disputes; identity andcultural discrimination; environmental threats,
criminalities, and poverty. Land con lict, rido/clan
con lict, armed con lict, and environmental issues
were the several con licts it had been successfullyreconciled. Land con lict is the major con lict inAlamada but it could be spilled over to rido andarmed con lict. Rido is a Muslim term for feuds,
which refer to a sporadic outburst of retaliatory
violence between families and kinship groups aswell as between communities. This violence ischaracterized by a sporadic outburst of retaliatory
violence between families and kinship groups. Thisphenomenon frequently occurs in areas where thegovernment or central authority is weak, and areas
where there is a perceived lack of justice andsecurity (Magno, 2007, p. 11). Brothers versus
brothers ight each other because of land disputes,
family members ight for political positions, and theindividual kills a member of his/her family becauseof KaPe (Kapangyarihan/Power and Pera/Money).
The problem of violence, according to Torres,emphasized that this phenomenon frequently occurs
in areas where the government or central authority
is weak and areas where there is a perceived lack ofjustice and security (Ibid).
Therefore, the root of this culture of violence may
be traced to self-serving value on the part of each
person like in business (protectionism cartel/monopoly behavior, tax evasion, etc.), in government(graft and corruption, etc.), other sectors(dishonesty, lack of concern for the common good,etc.) or personal interest (pride, anger, gluttony, lust,
avarice or covetousness, envy, and sloth). The
majority thinks that the problem is outside of themsuch as Money, Consumerism, and More money(MCM) or KaPe, etc., so each person focuses hisenergies on treating the problem. But we forgetspiritual values such as dialogue, love, and reason.
Fromm explains "... man, in any culture, is faced by agamut of possibilities: He is the archaic man, thebeast of prey, the cannibal, the idolater; but he is also
the being with the capacity for reason, for love, forjustice" (1994, p. 3).
Alamada Peace Journey
Alamada is a municipality of North Cotabato,
Mindanao, Philippines. Alamada is composed of 17
barangays; four of which are already classi ied asurban areas. These are Baragays Mirasol, Bao, Dado
and Kitakubong. As of 2009, it has a population of
55,865 people in 14,966 households. The populationis comprised of Christians, of which over 70% are
Roman Catholic; 12% belong to other Christiandenominations, while the remaining percentage
follows Islam and other indigenous Tribal religions(Lumad). This is called the Tri-people of Alamada.
More than half of the population speaks Ilonggo or
Hiligaynon. Many Alamadians are also luent in
Cebuano, Iranon, Ilocano, and Karay-a while
Maguindanaon, Manobo, and Maranao are used as
native dialects by minority groups in the area (EED,
2012, p. 18).
During the mayoral leadership of Hon. Bartolome"JUN" Lataza, Jr., advocates and political will topromote peace on a micro level because Alamada
was in constant con lict, war, and misunderstandingof Tri-people. According to him "Con lict settlement
was not all about us, nor for few people but generally
for the whole community," Jun wanted to change thepolitical paradigm of politics in Alamada but it isvery challenging because everyone dreams of thisculture of peace but only in words not in action.
During the term of Jun in public of ice, the priority
thrust is peacebuilding, moral recovery, andlivelihood. For Jun, the Culture of Peace can be
instituted for every person. The gains of each person
must be placed in its itting context: the sustainableimprovement of the quality of life for his family,community, and society. In other words, the cultureof peace needs to be primarily geared towards
responding to the peaceful self, peaceful family,
peaceful community, and peaceful society so that it
will not compromise the ability of future generations
to meet their needs and security. Any move toalleviate the culture of violence must ind an anchor
in each person's efforts to promote the culture ofpeace.
However, war has been a menace in Alamada. It
was 2008 were three Barangays of Alamada
experienced con lict that ended in bloodshed.
Thirteen houses were burned, four people died, andseven people were badly wounded. Such violent
incident keeps on recurring leaving thousands ofinnocent people especially children to evacuate andbe displaced from their farms and education (EED,
2012, p. 27). This echoes Fromm's notion of
necrophilic character, love of death, incestuous
symbiosis, and malignant narcissism, a regressive
character orientation, a malignant form ofdestructiveness, that touches the core problem ofevil in the modern world (2010, p. 16). That's why
Jun applies the Tri-people Hybrid Con lict Resolution
Approach to address this concern in Alamada.

f

f

f

f

f

f

f

f

f

f

f

f

f

f

f

f

f

f

Tri-people Hybrid Con lict Resolution Approach
To address the societal con lict, Alamada launchedseveral peace-building practices that would aim toeffectively settle longtime issues and constitute bestpractices among the community. Through a con lictmitigation approach, together with the personnel of
Alamada Municipal Police Station, the counterpart
from the Philippine Army, Barangay Of icials, andChristians-Muslim community leaders and Elders
went to the place to evaluate the actual situation to
decrease the tension and put an end to theaggressiveness and violent reactions of both parties
to avoid further escalation of the armed con lict
(EED, 2012, p. 28). The cases of rido in Alamada
weren't resolved using conventional legal means.
The Local Government Unit (LGU) of Alamada
employs the Alternative Dispute Resolution System
in settling con licts in the communities. Along thisline, among the steps taken was the creation of the
Tri-people Consultative Service Desk under
Executive Order No. 16, series of 2010. The councilof elders of this group is composed of 25 different
members from the Christian, Bangsamoro, andLumad communities. Through this process, con lictis mitigated and resolved through methods that thecommunities have been practicing for generations(Balay Mindanaw Foundation, Inc., 2013, p. 24).
This method was also experiential in theobservance of the Republic Act (RA) 9285 otherwiseff

Eubios Journal of Asian and International Bioethics 32(5) (September 2022)

141

known as the "Alternative Dispute Resolution of2004" (Lawphil.net, 2004). Speci ic interventions
like the creation of the Tri-people Consultative
Service Desk and recognition of the Tri-people local
governance and processes were primarily given
importance by the Local Chief Executive (mayor) insupporting the peace-building mechanism in
Alamada. It is hybrid because the LGU of Alamada
applied that mechanism by combining the informal
customary procedures of Moro people andIndigenous People in settling gaps in theircommunity. This was part of their ways to being
more engaged with communities in Alamada.
According to Jun Lataza, "There are standard or
given programs in the government. To strengthen
these, we incorporated peace-building advocacy anda peace lens in every program. We wanted to instill aculture of peace in the hearts and minds of thepeople. It's hard to move forward if peace is notachieved" (EED, 2012, p. 26). From a con lict-torn toa zone of peace municipality, Jun proudly shares themilestones and struggles behind the total success ofachieving peace engagements in Alamada. Together
with MPOC, they observed that rido is the grassroots
con lict that must be deeply concerned and settled
irst in Alamada. Working together with MPOC andusing Alternative Dispute Resolution (ADR) the
Town's Relationship (Ugnayan nang Bayan) at
Simbahan-Mosque were the best practices toreconcile rido in Alamada. MPO C's purpose is tonormalize and perform necessary actions on
regulating the practice of human rights in thecommunity. ADR is a reconciliation method
encouraged by the Philippine Supreme Court (Ibid).
The Tri-people Hybrid Con lict Resolution
Approach in enabling the culture of peace in
Alamada is very successful so far. As result, there
were at least 18 clan con licts were settled. One ofthese, including were the oldest clan con licts in themunicipality that had been preserved for 50 years.
That effective implementation of the reconciliation
mechanism compelled the declaration of the Zone ofPeace in Alamada. Every year, Alamada celebrates
the Week of Peace as its commitment to promoting
the region. Thousands of people from all walks of life
join the local government's call for peace and unity
among Christian settlers, Bangsamoro, and Lumads.
Series of Culture of Peace Training and Seminars areheld now and then. This is participated by local
leaders, Non-Government Of ices (NGOs), religious
and tribal leaders, and some academe. The
government and its local partner gathered morethan 10,000 signatures from various consultations
and discussions in the municipality in getting thepulse of the people in the said declaration (Ibid., p.
37).
Thus, Lataza as a Christian stresses that "We
could not have done this without Muslim
peacebuilders" (BMFI, 2013, p. 24). Jun continues "Ifthey had not helped us negotiate, we wouldn't havegone anywhere." Jun forged alliances with many
Muslim elders, the most notable of whom was142

Eubios Journal of Asian and International Bioethics 32(5) (September 2022)

Ustadz Ali C. Shariff (Bangsamoro). Shariff said
"Being a peace advocate, I learned to forget my old
self as a guerilla leader. When my brothers were
killed due to a land dispute, I brushed away the ideaof retaliation. Instead, I entrusted to Allah and ourgovernment the people who were responsible for mybrother's death. I believed that peace anddevelopment could only be achieved if we
understand and love each other as brothers andsisters." Likewise, Timuay Danny Mansalinta, Jr. a
Manobo (Lumad) agreed and he said "We were
happy that inally, we were recognized by thegovernment. The importance is given to us - Lumads
impelled us to support the local government's main
thrust which is to create peace in our community."
Also, Sultan Bagiul Butig said "Muslim, Christians,
and Lumads should Unite. Mrs. Helen Guling a Social
Welfare Assistance of DSWD said "the peace
initiatives spearheaded by the local government unitof Alamada have brought a positive result. People nolonger live under the shadows of fear andrestlessness. Perhaps it's because the LGU of
Alamada has encouraged everyone-the Christiansettlers, the Bangsamoro, and the Lumads to get
involved and participate in building a peaceful andprogressive community." This was supported by The
Tri-People Consultative Service has resolved several
family feuds in the area and has helped inspearheading peace dialogues and negotiations not
only in Alamada but in nearby municipalities as well.
A series of programs anchored on peace were also
created to help alleviate poverty and avoid armed
con lict. Some of these are the Munisipyo sa
Barangay (Municipal in Barangay) program. Moral
Recovery Program, Disaster Preparedness Program,
Eco-tourism, and School of Peace Program (Ibid., pp.
32, 33 & 37).

f

f

f

f

f

f

f

f

f

Dialogue, Love, and Peace
In strengthening the function of the Municipal
Peace and Order Council (MPOC) of Alamada, where
the mayor is the chairperson, they conductedconsultations and interfaith/interreligious dialogues(Dialogue of words, dialogue of Life, dialogue of
religious experiences, dialogue of actions, andDialogue of Values and Cultural interest) adhering to
the power of inclusion. This effort got the big respectof religious and traditional institutions. A council ofelders was created comprised of the traditional
elders of all beliefs to make the reconciliation
process more inclusive and systemic (Act for Peace
Programme, p. 38-39). Even, the United Nations
Development Programs (UNDP) debates that a
Culture of Peace can be attained through genuine
dialogue.
The different dialogues the dialogue of words is adialogue using words that give life or positivity suchas star power words like sorry, I love you, you areimportant, etc. rather than uttering words that down
the dignity of one person such as Muslim areterrorist, Christians are land grabbers, etc. thesewords are unauthentic dialogue and lead tomisunderstanding/con lict. Dialogue of life is adialogue to protect life such as dialogue between
con lict persons or groups that will cause war, killing
another person, or clan wars like rido, etc. The
dialogue of religious experiences is the dialogue
between different groups such as Christian, Muslim,
Lumads, or Indigenous Groups (IGs) so that theissues and concerns of each group will be addressed
and will not lead to con licts or violence. Dialogue ofaction is walking the talk. It is important to put into
action the words that are agreed upon by each
person or group. An example of this is those who
help the poor, the disadvantaged, or those who are
affected by war and con licts. This action is very
important so that words will not only well say but
it's well done. Lastly, the dialogue of values andcultural interest in respect to the different culturaldifferences by valuing each person with different
interests but one humanity. Macer supported thisand said "There is no civilization on earth that has
not been enriched by contact, interaction, andexchange with others. Within civilizations, too,interactions and exchanges bring similar rewards.
Civilizations are thus in constant dialogue not onlywith each other but also with themselves" (2010, p.
115).
This dialogue is a result of the love that unites thetri-people in Alamada. Fromm highlighted that "Loveis union with somebody, or something, outside
oneself, under the condition of retaining theseparateness and integrity of one's self. It is anexperience of sharing, of communion, which permits
the full unfolding of one's inner activity" (1955, p.
31). While, Macer supported this and he said "Lovein different expressions is a common element in our
biological, social, and spiritual heritage, that
constructs our religious and cultural identity" (2010,114). Thus, this love will result in a peacefulcommunity. Thus, Casto and company highlighted
that,“In today's world, a culture of peace should be seenas the essence of a new humanity, a new global
civilization based on inner one- ness and outer
diversity. The lourishing of a culture of peace will
generate the mindset in us that is a prerequisite forthe transition from force to reason, from con lict andviolence to dialogue and peace. A culture of peace will
provide the bedrock of support to a stable,
progressing, and prospering world for all “(2010, xi).
Thus, the idea of the culture of peace echoes
Fromm's notion of biophilic character which is thelove of life, independence, and the overcoming of
narcissism (2010, p. 2). The seeds of peace asre lected in the capacity-building and strategic
peace-building activities have been sown andplanted in the hearts and minds of the Christiansettlers, Bangsamoro, and the Indigenous Peoples(IPs) over the years. The accumulated positive
experiences of living and working together havebrought about a favorable climate conducive todeveloping their potential and achieving their goals
and aspirations in life. This once-obscure town inEubios Journal of Asian and International Bioethics 32(5) (September 2022)
North Cotabato is now ready to showcase its besttreasures to the public. It is hoped that these willserve as a vehicle to promote peace and unity among
the Alamadians and attract more visitors (EED,
2012, p. P. 45).
Conclusion
The journey of Tri People toward the Culture ofPeace became fruitful. Back in November 2010,
Alamada celebrated its irst Mindanao Week ofPeace. More than 8,000 attended the event.
Christians, Lumads, Muslims, soldiers, and rebels
alike signed the wall of peace, a covenant on theircommon goal, in the Alamada town gymnasium.
Everyone was present – the priest, nuns, soldiers,
students, and all sectors of society, even members of
the Moro National Liberation Front," says Lataza(BMFI, 2013, p. 25). Alamada also is blessed with its
abundant natural resources and they have beenchampioning the protection of the environment andecotourism like Asik-Asik falls. Asik-Asik was before
a surveillance area of revolutionary fully armed
groups which made the falls untouched by the
locales and unreached by the government support.
The LGU succeeded in conducting a total inclusive
dialogue with the rebel force leaders and come up
with the peace agreement. As result, Asik-Asik falls
made the majestic falls open to the public.
Then, they also accomplished to execute an
Integrating of Peace Education into Basic andTeacher Education at all academic institutions in themunicipality, including Madrasa schools. According
to Ms. Jessette F. Morales – School Principal "Peace iswhat we are dreaming of where the children, parents,
teachers and school heads will have to leave harmony
with each other" (Ibid).
T h e re f o re , t h e j o u r n e y o f A l a m a d a i npeacebuilding is very successful until now. The newleaders incorporated the culture of peace in every
program of the municipality and they are now in theprocess of restorative justice. According to thepresent Mayor Hon. Jesus Sacdalan "There is nosustainable peace without sustainable
development". Therefore, a Culture of Peace is not
only a concept, but it is a Choice. The promotion of a
Culture of peace through dialogue which isessentially rooted in love becomes the ethicalsolution and key to the Tri-people hybrid Resolution
in Alamada, North Cotabato.

f

f

f

Acknowledgment
This research is not possible without the
supported of Hon. Bartolome "JUN" Lataza, Jr., a
Mindanao Peace Institute alumni who learned theCon lict Management course and Restorative Justicecourse in 2011 and 2012, during the peacebuilding
training, a currently Municipal Councilor (2019present), Former Municipal Mayor for 3 years(2010-2013), former Vice Mayor for 9 years(2001-2010), and a Councilor for 3 years(1998-2001). With 17 years of experience in the
Armed Forces of the Philippines and 5 years in the

143

Philippine National Police, he acquired complete
knowledge on how to merge the defense strategy,
con lict management, social engagement, and peace
approaches. Also, through the support of Hon. Jesus
Sacdalan – Municipal Mayor (2019-Present) andformer Congressman, Hon. Leonigildo “Toto”
Calibara - Municipal Vice Mayor, Local Government
Unit of Alamada, North Cotabato, Mrs. Helen Guling a
Social Welfare Assistance of DSWD, Ustadz Ali C.
Shariff the chairperson of Tri-people Consultative
Desk, Sultan Bagiul Butig (Muslim), Timuay Danny
Mansalinta, Jr. a Manobo (Lumad), and Ms. Jessette F.
Morales – School Principal (Christian).
References
Act for Peace Programme (2006), Provincial Technical
Working Group Formation Workshop for Cotabato
Province, Kidapawan City, North Cotabato: United
Nations Development Programme.
Adams, David (2005), The Year 2000: International Yearfor the Culture of Peace and the Manifesto 2000,
December, See https://www.culture-of-peace.info/
copoj/iycp.html
Balay Mindanaw Foundation, Inc., (2013), Peace Journeys:
A Collection of Peacebuilding Stories in Mindanao,
Cagayan De Oro, Philippines.
Betita, Venus., et al., (2014), Moving Beyond: Towards
Transitional Justice in the Bangsamoro Peace Process,Philippines: Forum Ziviler Friedensdienst (ZfD).
Castro, Loreta Navarro, & Galace, Jasmin Nario (2010),
Peace Education: A Pathway to a Culture of Peace,
Quezon City, Philippines: Center for Peace Education,
Miriam College.
Einstein, Albert (1968), Einstein on Peace, Nathan and
Norden, ed., New York: Schocken.
Evangelischer Entwichklungsdienst (EED) / Church
Development Service, Ziviler Friedensdienst (ZfD) /Civil Peace Service and Local Government Unit ofAlamada (2012). Alamada Peace Journey, Philippine.
https://youtu.be/hN3UTLhdmSY
Fromm, Erich (1942), The Fear of Freedom, London,
Routledge & Kegan Paul.
___________ (1955), The Sane Society, New York, Rinehart
and Winston, Inc.
___________ (1956), The Sane Society, New York: Routledge
and Keagan Paul.
___________ (1964), The Heart of Man, Its Genius for Goodand Evil, New York: Harper and Row, 1964;
Republished with American Mental Health Foundation2010.
________ (1994), On Human Being, Edited and with a
Foreword by Rainer Funk, New York, The Continuum
Publishing Company.
___________ (2004), Forum (English version) 8 / 2004,
Tuebingen, Selbstverlag.
Gaudium Et Spes (1965), Pastoral Constitution on the
Church in the Modern World
Promulgated By His Holiness, Pope Paul VI On December
7. See http://www.vatican.va/archive/hist_councils/
ii_vatican_council/ documents/vatii_const_19651207_gaudium-et-spes_en.html

144

Eubios Journal of Asian and International Bioethics 32(5) (September 2022)

Macer, Darryl R.J. and Saad-Zoy, Souria (2010), Asian-ArabPhilosophical Dialogues on War and Peace, Bangkok:
UNESCO.
Mayor, Federico (2011), The Development of Culture ofPeace and Non-Violence (1988-2010), Barcelona: S.A .de
Litogra ia.
The LawPhil Project (2004), Republic Act No. 9285,
Philippines, April 2, 2004, https://www.lawphil.net/
statutes/repacts/ra2004/ra_9285_2004.html
Torres III, Wilfredo Magno (2007), Rido: Clan Feuding andCon lict Management in Mindanao, Philippines: The
Asia Foundation.
United Nations Educational, Scienti ic and Cultural
Organization (1989), Building A Culture of Peace. See
https://internationaldayofpeace.org/culture-ofpeace/_____________ (1989), Declaration on Peace in the Minds ofMen, Yamoussoukro, Côte d’Ivoire, 1 July.
Zizek, Slavoj (2008), Violence: Six Sideways Re lections,
New York: Picador.

Discharge support practices ofnurses in NICUs in Niigata
Prefecture, Japan- Mio Tanakaa,- Subasinghe Pathirannahalage Kalpana Jeewanthi
Subasingheb,- Tomoko Sumiyoshia,b,- Nao Seki a,- Utako Shimizua,- Hiroshi Kobayashi c,- Akurugoda Mahanakathige Shyama Deepanie
Pathiranage,ba Faculty of Health Sciences, Niigata University,
Niigata, Japanb Department of Nursing, Faculty of Allied Health
Sciences, University of Peradeniya, Augusta Hill, Sri
Amarawansa Mawatha Peradeniya, Sri Lanka
c Niigata College of Nursing, Japan
E-mail: Mio Tanaka mio@clg.niigata-u.ac.jp

f

f

f

f

f

f

f

Abstract
In Japan, the role of discharge support nurses inneonatal intensive care units (NICUs) is becoming
more important as the survival rate of newborns
increases. The purpose of this study was to clarify
the discharge support practices of nurses in the
NICU in Niigata Prefecture. A descriptive, crosssectional study was conducted among dischargeplanning nurses (DPNs) working in NICUs in Niigata
Prefecture. The survey items included basic
attributes, planning skills of DNPs (measured using
the Japanese version of the Nurses' Discharge
Planning Ability Scale [ J-NDPAS], learning
opportunities, environment for consultation, and
dif iculties. Sixteen DNPs (response rate: 85.7%)
were included in the analysis. The average age of the
respondents was 42 years. Eighty percent of themexperienced dif iculties with discharge support, and
50% of them had no opportunity to learn. The
learning opportunities and satisfaction pertaining todischarge support signi icantly differed among highand low J-NDPAS scores. It is important to evaluatedischarge support in the NICU and educationals u p p o r t to c re a te a c o n t i n u o u s l e a r n i n genvironment.
Introduction
Discharge planning is a process that helps maintainthe continuity of patient care from in-hospital care to
the care provided in the community. The concept ofdischarge planning was developed and promoted in
the 1960s in the United States to provide a better
understanding to the family, patient, and community
about the post-discharge period, thereby reducing
post-discharge complications and improving thequality of life of the patient and their family(Shepperd, et al., 2013). Furthermore, studies havefound that effective discharge planning reduces thelength of hospital stay and the likelihood ofreadmission. With the expansion of the process ofdischarge planning worldwide, systems that connect
the hospital and social services in the community
have also been developed (Lin, et al., 2021;
Gonçalves-Bradley, et al., 2016; Nelson, et al., 2000).
As nurses play a vital role in patient care,discharge planning became an integral part of thenursing care process during the 1990s (Lin, et al.,2021). Discharge planning interventions conductedby nurses have been shown to be effective in
reducing readmissions and post-discharge
complications (Ekim, et al., 2016; Zhu, et al., 2015;
Fox, 2016). Japanese nurses tend to be more
involved in discharge planning than nurses in other
Asian countries, such as South Korea and Thailand(Tsujimura, et al., 2016). At present, although nurses
are aware of the importance of discharge planningand know that discharge planning should begin on
admission, many factors such as busy wards,
communication barriers, lack of staff, lack of policies
and guidelines, and inadequate support from social
services may prevent them from implementing
discharge planning in practice (Wong, et al. 2011;
Tomura, et al. 2017). Most nurses prioritize patientcare and only conduct discharge planning after the
doctor has decided to discharge the patient (Graham,
et al., 2013; Domoto, et al., 2014).
Although less studied, discharge readiness andrisk assessment of the post-discharge period inneonatal intensive care units (NICUs) are vital for
providing a better transition from hospital to homecare. Establishing parenting after NICU discharge is acomplex process compared to other acute caresettings (Dellenmark-Blom, et al., 2014). Lack ofproper discharge planning for NICU patients canlead to severe emotional problems in the family
during the post-discharge period. Discharge
readiness of the family should be assessed inadvance to ensure parental satisfaction and patient
safety (Purdy, et al., 2015; Arad, et al., 2007). Family-oriented discharge planning programs have beenshown to reduce healthcare utilization and healthcosts during the post-discharge period (Ingram, etal., 2016). Nurses have to maintain a close
relationship with patients’ families during their stay
and after discharge, and have a good understandingof the family environment to provide balanced
discharge planning (Smith, et al., 2009). Nurses areat the forefront of helping family members develop
the necessary skills to take care of their children at
home. Therefore, nurses play many roles in the
discharge process, including those of educators andcollaborators (Góes, et al., 2017). In recent years inJapan, there has been a signi icant increase in thesurvival rate of newborns with complex medical careneeds (Hahn, et al., 2011; Nakanishi, et al., 2018). In
Japan, new interventions for newborn screening
have been implemented, and the roles of NICU
nurses have changed (Kyozuka, et al., 2016). Surveys
have revealed the need for policies and programs toincrease the skills of discharge planning nurses(DPNs) in Japan (Tomura, et al., 2017).
In recent years, the survival rate of newborns withcomplex medical needs has increased (Hahn, et al.,2011). There is a need for studies to identify gaps inthe current practices of NICU discharge planning andeffective interventions to ill the gaps identi ied. Suchstudies would enable improvements in the discharge
process. The repeated use of health services in the
post-discharge period of newborns discharged from
NICUs can be prevented using an effective nurse-led
discharge process. In Japan, national guidelines forthe improvement of the perinatal care system were
established in 2010, and Niigata Prefecture has beenworking to resolve issues by assigning NICU
hospitalization support coordinators. Five years
have passed since the establishment of the system,
and as part of the evaluation of the current support
for discharge from the NICU; we conducted a surveyof the actual situation.
The purpose of this study is to clarify the status ofdischarge support for among DPNs working in NICUs
in Niigata Prefecture.

f

f

f

f

f

f

f

f

Term De inition
While looking forward to their post-discharge lives
together with the patients and their families, andaccompanying their thoughts in a series of processes
so that their medical treatment lives become
possible” (Volland, 1988). Discharge support also
includes "discharge coordination," which comprises
activities to provide specialized support for thereconstruction of the lives of children hospitalized in
the NICU and their families so that they can leadstable lives in terms of physical, mental, and social
aspects after discharge from the hospital, throughcoordination and cooperation with professionals
inside and outside the hospital" (Tanaka, 2015).
DPNs are de ined as "full-time or dual-purpose
nursing staff engaged mainly in discharge support
work in discharge planning departments and who
are responsible for helping the discharge of patientsff

Eubios Journal of Asian and International Bioethics 32(5) (September 2022)

145

admitted to the ward" (Tomura, et al., 2017). In thisstudy, nurses who provided hospital discharge
support were also included in the DPNs. The reason
for this is that the number of nurses who belong to
the discharge planning department and provide
discharge support in the NICU is extremely small in
Niigata Prefecture. As most of the actual discharge
support is provided by the nurse as a discharge
coordinator in the NICU, we conducted the survey as
DPNs.
Methodology
Study Design
A descriptive cross-sectional study.
Study Sample
All DPNs working in NICUs in Niigata Prefecturewith more than three years of experience in the
NICU and working as full-time or part-time nurses
were included in the study sample.
Data collection methods
The nursing of icer in charge of each unit was
contacted by phone, and details were obtained about
the number of DPNs in a particular unit. The NICUs
in Niigata Prefecture (as of the September 2016
survey) include three perinatal medical centers(PMC）and four Regional perinatal centers (RPC).
Two RPC facilities were excluded from this survey
because they did not accept external patients(Niigata Prefecture Perinatal Medical Network
Demand Information). The actual number of RPCs
was set at two, bringing the total number of facilities
surveyed to ive. There were approximately 150
nurses in total in the ive NICUs, and among them,according to the interviews with the heads of NICU
divisions, three to eight nurses in each facility had
the role of DPN, or discharge support nurse. We
distributed ten copies of the survey to each PMC andive copies to each RPC and asked the head nurses to
distribute the survey to nurses who met therequirements of the target group. Information sheets
and consent sheets were sent to each unit throughthe mail, and the investigator obtained informed
written consent from the participants. The sample
size was set at 28, based on the number of eligible
nurses provided by the NICU head nurse.
The researchers obtained written informed
consent from eligible DPNs in each unit. The
researchers distributed questionnaires to the headnursing of icer in each unit and asked them to
distribute the questionnaires to the eligible DPNs intheir units. The completed questionnaires werereturned to the investigator via mail.
Data Collection Tools
A pre-tested, standard, self-administeredquestionnaire was used. The questionnaire collected
demographic data, professional experience, andyears of experience as a NICU nurse and as a DPN. To
assess the current discharge planning process,questions on the following aspects were included in
the questionnaire:
1. Attributes
2. The DPNs’ discharge planning ability was

146

Eubios Journal of Asian and International Bioethics 32(5) (September 2022)

measured using the Japanese version of the Nurses’
Discharge Planning Ability Scale (J-NDPAS), which
has been tested and validated (Tomura, et al., 2013).
This scale comprises the following four subscales:• Subscale 1: Ability to carry out informed consent
with the patient and family. (seven items)•

Subscale 2: Ability to balance care after
estimating the date of discharge. (six items)•

Subscale 3: Ability to balance care after
discharge. (six items)•

Subscale 4: Ability to prepare for the shift ofmedical treatment ( ive items)

The answers to each item were measured on a 5point scale: 1 = not at all; 2 = poor; 3 = neither goodnor bad; 4 = good; and 5 = well done. For each item,the mean values of the responses were calculated.
Adjustments were made to the original scale withthe permission of the developer (Prof. Tomura) tomake the scale applicable to the NICU setting. The
words “care” and “care manager” were changed to“child-rearing” and “social worker,” respectively. In
addition, the expressions were changed in this study,
and the reliability was examined in each subscale.
3. The status and perception of hospital discharge
support・ Av a i l a b i l i t y o f l e a r n i n g , c o n s u l t a t i o nopportunities, and dif iculties related to hospitaldischarge support (yes or no)・Perceptions of the importance of dischargeplanning, answered on a scale of 1 (not conscious atall) to 5 (always conscious).
・Level of satisfaction with their job, measured on ascale of 1 (strongly disagree) to 5 (strongly agree).
Ethical considerations
The study was approved by the Institutional
Research Ethics Committee of the authors’ af iliatedinstitution. All participants provided written
informed consent. It was ensured that participation
was voluntary and that anonymity was maintained.
(Approved in April 2015)

f

f

f

f

f

Data Analysis
Demographics and satisfaction levels were reported
as mean (M) and standard deviation (SD) separately
for perinatal medical centers and regional perinatal
centers. For the discharge conference, the number ofparticipants was tabulated. Since the J-NDPAS has
been reworded, alpha coef icients were calculated
for each subscale to check for reliability (Table 1).
The J-NDPAS total score was divided into two groups
based on the median score: a high-score group and alow-score group. Comparisons between the twogroups were examined using the t-test for age andFisher's direct probability test for the other items.
Statistical analysis was performed using SPSS
version 23 (IBM Corp., Armonk, NY, USA).

Table 1: Overview of discharge planning nurses(range) n=16
Characteristics(Range)Perinatal
M e d i c a lCentern=10

Regional
Perinatal
Centern=6

Basic Attributes

M

M

GenderAll female

All female

Age (27–57)

43.6±9.8

39.8±5.5

Experience as a nurse

18.6±10.6（5-35）

15.7±4.5（10-21）SD

SD

Experience as a nurse at 8.5±5.6
NICU（1–17）

6.5±1.8（4–9）

Experience as a discharge 6.3±5.7
planning nurse（1–17）

3.9±2.0(1–5)

more than 1 year but
less than 3 years

42

more than 4 years but
less than 5 years

31

6 years to less than 10 1
years

3

more than 10 years

20Provide full-time hospitaldischarge support

20

Positions (Multiple responses）
head nurse

5

Assistant Chief Nurse

25discharge support nurse

51

Nurses with other quali ications (Multiple responses）
Case worker・Support
Counseling Specialist

3

1

Public health nurse00Midwife1

1

Overview of the belonged hospital
Number of Hospital Beds

（649–824）（262–478）

Number of Hospital Beds
at NICU（9–12）（6）

Number of Hospital Beds at
GUC（12–21）（6-8）

Average length of stay inhospital at NICU

（33.2–45）（24.6）

Average length of stay inhospital at GCU（35.2–67.2）

Eubios Journal of Asian and International Bioethics 32(5) (September 2022)
Results
The response rate was 86％. Of the 28
questionnaires sent, 24 nurses responded via mail.
Out of the 24 responses, eight were deleted because
their responses to J-NDPAS were incomplete. The
analysis was conducted using the 16 complete
responses. All the participants were women. Of the
respondents, ten belonged to Perinatal Medical
Centers (PMCs) and six belonged to Regional
Perinatal Centers (RPCs).

147

Participant Demographic Characteristics
The mean age of the participants was 42.4±8.8
years (range 27–57). They had a mean of 17.5±8.8
years’ experience as a nursing professional; a meanof 7.7±4.5 years’ experience as a NICU nurse; and amean of 5.4±4.7 years’ experience in NICU dischargeplanning.
The current positions or titles of the respondents
were as follows: ive discharge support staff, twohead nurses, two deputy head nurses, four chief
nurses, and four staff nurses, with 15 respondents
holding concurrent positions and two holding parttime positions. (Table 1)

Table 2: Effectiveness of the guidebook – Paired t-test for each item of J-NDPAS (n=16)
Regional
Perinatal
Center
n=6

M

SD

M

SD

Subscale A1. When starting the support, image the overall 3.60
The capability to carry picture and low of support up to discharge at an earlyout agreed information stage.
with the patient andthe family(α:.84）

0.84

3.33

0.52

2. Predicting medical management and daily life 3.70
assistance that patient need after discharge.

0.67

3.50

0.84

3. Predict the possibility of continuing childcare 3.40
support by family, taking into account the patient’s
post-discharge course.

0.70

3.67

1.03

4. Understanding the living environment of patients 3.60
after discharge.

0.84

3.67

1.03

5. Quickly obtain information on medical institutions 3.10
and home-visit nursing that can provide the medicalcare and care that patients need after discharge.

0.74

3.17

0.75

6. Assess the medical care and care needed by the 3.20
patient after discharge from the family with theirchild-rearing ability and local resources.

0.92

3.33

0.82

Subscale B- Capability 7. Con irm how the patient and family understand the 3.50
to care balance after patient’s medical condition and progress aftere s t i m a t i n g t h e discharge.
discharge(α:.76）

0.71

3.67

0.52

8. Understanding the anxiety associated with the 3.80
discharge of a patient/family.

0.42

3.83

0.41

9. Provide information so that patients and their 3.60
families can understand the burden of childcare after
discharge from the hospital.

0.70

3.33

0.82

10. Find out if the family is ready to take care of 3.80
children.

0.63

4.67

0.52

f

Perinatal
M e d i c a lCentern=10ff

Item of Subscale

Items of J-NDPAS

148

Eubios Journal of Asian and International Bioethics 32(5) (September 2022)
11. Create a feasible support plan in consideration 3.60of the patient’s/family’s intentions.

0.84

3.83

0.98

12. Encourage patients and their families to make 2.90
proactive decisions about discharge plans andpreparations.

0.74

3.17

0.98

13. Adjust if there is a difference between the 3.50
intentions of the patient/family and the policy ofthe hospital staff.

0.53

3.50

0.84

Subscale C- Capability 14. Coordinate medical management and care during 3.60
to care balance after hospitalization with hospital staff to reduce thedischarge adjustments burden on patients and their families after discharge.
(α:.73）

0.52

3.33

0.82

15. You and your hospital staff will help the patient 3.10
and their family maximize their independence (ADLand self-care skills) during their stay in the hospital.

0.88

3.50

1.05

16. Devise instruction methods with the staff inside 3.30
and outside the hospital to make it easier for patientsand families to learn medical management and care.
techniques.

1.25

3.33

0.52

17. Depending on the patient’s situation, select the 3.10
necessary members from the hospital staff for
hospital discharge support.

1.10

3.83

0.75

18. Share hospital discharge goals among hospital 3.60
staff involved in patient discharge support.

0.70

3.17

0.98

19. Adjust local staff to master inexperienced medical 2.50
management and care skills.

1.18

3.33

0.52

Subscale D- Capability 20. When using the medical and welfare systems, 3.50
t o m a k e s h i f t arrange necessary procedures, taking into accountp r e p a r a t i o n o f a the time required for accreditation.
m e d i c a l t re a t m e n tplace （.71）

0.97

3.00

0.89

21. Timely securing of medical institutions and home- 3.40
visiting nursing that can perform necessary medical
management and care after discharge.

0.97

3.17

0.75

22. Coordinate with family and consulting support 3.90
specialists so that the post-discharge treatment
environment can be prepared before discharge.

0.57

4.00

0.63

23. Depending on the patient’s condition, select the 3.80
means to transfer the patient to their home whenleaving the hospital.

0.63

4.33

0.52

24. To achieve the purpose of the joint conference, I 3.90
arranged for patients, families, and necessary staff
inside and outside the hospital to participate.

0.74

4.17

0.41

13.9

2.04

14.3

1.38

total Score(α:.91）Eubios Journal of Asian and International Bioethics 32(5) (September 2022)

149

Table 3: Relationship between J-NDPAS scores, DPN experience, and perceptions of discharge support (n=16)
J-NDPAS

High score groupn=8

Low score groupn=8n(％)orM±SD

n〔％〕orM±SD

Agea

43.9±9.3

40.9±8.56(Range)range (30–56)

range (27–57)

Experience as a nurse (years)b

20.6±9.6

14.7±6.6

H i g h 5(62.5）

3（37.5）

L o w 3(37.5)

5（62.5）(17.5<)(≦17.5)Experience as a nurse at NICU b
(7<)
(≦7)

7.8±5.1(≦5)

p-value

0.73

0.513

0.619

7.6±3.9H i g h 4(66.7）

2（33.3）

L o w 4(40.0)6（60.0）Experience as a discharge planning 5.0±5.2
nurseb
<)

t

0.608

5.8±4.2

High(5 4(57.1）

4（42.9）L o w 4(44.4)

5（55.6）

1.00

Learning opportunity on NICU discharge adjustmentb
Yes

2(22.2)7(77.8)No

6(85.3)1(14.3 )0.041*

Place to consult about discharge planning adjustment b
Yes

6(46.2)7(53.8)No2(66.7)1(33.3 )1.00

Having dif iculty when coordinating with multiple occupationsbYes

6(46.2)7(53.8)No2(66.7)1(33.3)3.9±1.0

3.0±0.5

High

6(85.7)1(14.3)Low

2(22.2)7(77.8)Job Satisfactionb

a: Independent t-test

0.041*

b: Fisher's exact test SD: standard deviation * p<0.05

Status of Discharge Support Conferences
Among the nurses who responded to the survey,
14 (88% PMC: 9, RPC: 5) had held a joint predischarge conference. The main participants at theconference were the following: primary nurses(PMC: 9, RPC: 6), family members (PMC: 9, RPC: 5),

f

1.00

caseworkers (PMC: 8, RPC: 6), public health nurses(PMC: 7, RPC: 6), physicians (PMC: 9, RPC: 5), childadvocacy specialists (PMC: 6, RPC: 7), head nurses( PMC: 8, RPC: 0), and home care/in-home nurses(PMC: 8, RPC: 0).

Eubios Journal of Asian and International Bioethics 32(5) (September 2022)

The following are PMC-only participants andnumbers: patient (3), social welfare council (3), childdevelopment support facilities (3), home-helpers(2), physical, occupational and speech-languagehearing therapists (2), pediatric nurses (2), family
physicians (1), municipal welfare of icers for thedisabled (1), and outpatient nurses (1)Participants’ perceptions of the importance ofDischarge Support and Job Satisfaction
Regarding the importance of discharge support,nine nurses (56％) answered "very much so," four
nurses (25%) answered “fairly much so,” and three
nurses (19%) answered "agree," indicating that all
nurses recognized the importance of discharge
support. When asked about their satisfaction with
discharge support, 14 (88%) of the respondents
recognized its importance, including two (13%) who"very much agree," ive (31%) who "fairly agree," andseven (44%) who "agreed.” Most nurses felt that
their work was worthwhile, and their overall
perception of importance was high.
Dif iculties, Learning, and Consultation
Opportunities
Of the 16 nurses, 13 (81%) responded that they
had experienced dif iculty in coordinating with theinterdisciplinary team regarding discharge. To thequestion, “Did you have any chance to learn about
discharge planning for NICU hospitalized children?”nine (56%) answered “yes,” seven (44%) answered“no.” Of the 16 nurses, 13 (81%) had a place toconsult about discharge planning.

f

f

f

f

f

f

f

f

f

f

f

f

Discharge Planning Ability of NICU nurses
The means and standard deviations of each item of
the J-NDPAS for the perinatal medical
center andthe regional perinatal center are shown in Table 2.
For the perinatal medical center, the items with thehighest mean scores were "22. Coordinate withfamilies and care support specialists (caremanagers) to prepare the post-discharge careenvironment before discharge (3.90+0.57)" and "24.
Coordinate the participation of patients, families,
and necessary staff inside and outside the hospital toachieve the purpose of the joint conference(3.90±0.74)." The two with the lowest scores were"19. Adjust local staff to master inexperienced
medical management and care skills (2.50±1.18)”
and “12. Encourage patients and their families tomake proactive decisions about discharge plans andpreparations (2.90±0.74).”
In the regional perinatal medical center, indescending order of the mean score, the items withthe highest mean scores were “10. Make sure thefamily is ready to take care of the child (4.67±0.52)”
and “23. Depending on the patient’s condition,choose the means to transfer the child to the homeupon discharge (4.33±0.52).” On the other hand, theitem with the lowest mean score was “20. Whenusing the medical and welfare systems, take

f

f

150

necessary procedures into consideration the timerequired for certi ication (3.00±0.89).”
Participants’ characteristics related to J-NDPAS
scoresTable 3 shows the characteristics associated withthe two groups with high and low J-NDPAS scores.
The mean age at the time of the survey was 43.6
years for the high-score group and 39.8 years for the
low-score group. There were no statisticallysigni icant differences for age, years of clinicalexperience, years of experience in the NICU, or yearsof experience in discharge support.
Although there was no statistically signi icant
difference between the two groups in terms of theavailability of a counselor and perceptions of
dif iculties in discharge support, 14 nurses hadlearning opportunities and 14 nurses had
perceptions of dif iculties in support.
On the other hand, there was a statisticallysigni icant difference between the two groups
regarding the learning opportunities for discharge
support and job satisfaction. In the group with thehigh J-NDPAS score, six (75%) had no learning
opportunities, whereas seven (77.8%) nurses had
the opportunity to learn but had a low J-NDPAS
score. In the group with a high J-NDPAS score, six(85.7%) felt rewarded, whereas seven (77.8%) in thegroup with low scores also had a low perception of
reward.
Discussion
In this study, we identi ied the current discharge
support practices of DPNs in NICUs. The DPNs werecharacterized as having 6.26 years of discharge
support experience in perinatal medical centers and3.88 years in regional perinatal centers. This was 0.7
to 3 years longer than the average of 3.1 years in the
results of a national survey of DPNs at medical
centers with more than 100 illnesses conducted in2014 (Tomura, et al., 2017). This study was
conducted after the 2010 revision of medical fees
and the construction of the national guidelines forthe improvement of the perinatal care system andive years after the placement of NICU inpatient
support coordinators in Niigata Prefecture. At theperinatal medical center, DPN activities had started
before that time, and the staff in charge were foundto be building their careers. In both centers, there
were many cases of DPNs who had worked in the
NICU department before becoming DPNs, suggestingthat there is a possibility that new DPNs will be
appointed from among the NICU staff following theestablishment of the "additional hospital discharge
support" program. In this survey, 13 respondents(81.1%) experienced dif iculties in providing
discharge support. Other survey results havereported that DPNs in NICUs have higher dif iculties,e s p e c i a l ly i n c o o rd i n a t i n g w i t h m u l t i p l e
professionals.
In our study, we found that nurses who scoredhigh on the J-NDPAS felt high job satisfaction,

Eubios Journal of Asian and International Bioethics 32(5) (September 2022)
whereas nurses who scored low tended to feel low
job satisfaction. Previous studies have shown that
nurses' job satisfaction is associated with improved
patient outcomes and quality of care (Boamah, et al.,2018). Nurse-led discharge planning programs havebeen shown to increase nurses’ and families’
satisfaction (Wilson Smith, et al., 2018).
It was reported that staff conferences as acollaborative learning strategy for nurses (Arroyo, etal., 2008; Suzuki, et al., 2012) were important toovercome the dif iculties of DPN. Conferences havebeen reported to have a positive impact on nurses'
attitudes toward the discharge planning process,interdisciplinary communication and collaboration,and knowledge of patients' post-discharge care. The
system of community-based comprehensive care forchildren is underdeveloped, unlike the system ofcommunity-based comprehensive care for theelderly. In particular, support for hospital discharge
is complicated because of unclear coordinators andlarge regional disparities. In addition, because thenumber of support cases is very small, it is very
dif icult to gain experience in this ield. Therefore, it
is important to reduce the dif iculties of discharge
support for DPNs.
In addition, nurses with high J-NDPAS scoresshowed a tendency to have no place for consultation,
whereas nurses in the low score group had a place
for consultation. The average number of years ofexperience of the nurses in the high-score group was
20.6 years, and that of the low-score group was 14.7
years. Although there was no statistically signi icant
difference, it was inferred that some nurses in thehigh-score group were able to cope with the complex
process of discharge support and were responsible
for solving problems on their own.
Regular evaluation of the practical skills of DPNs
in the NICU is required in the future. In addition, it
has been reported that the ability to coordinate postdischarge care is related to the DPN's years ofexperience, whether or not they have experience inhome nursing, and whether they conduct selfimprovement activities such as reviewing cases inwhich they have provided discharge support (ProfTomura). It is important to provide opportunities fortraining programs at home and in the community tosupport the career development of DPNs.
Limitations
This study has some limitations. The results may
not apply to other cultural groups outside Japan.
Moreover, the J-NDPAS scale was originally tested
and validated in an older adult population. Althoughadjustments were made to the original scale to makeit applicable to the NICU setting, this may haveaffected the validity of the results measured by the JNDPAS.

f

f

f

f

f

f

f

f

f

f

f

f

f

f

f

f

f

Conclusion
This study clari ied the characteristics ofdischarge support in the NICU and the actual
situation of practical skills. The results showed that151

the number of years of experience among the DPNs
here was longer than that of DPNs in general medical
institutions with more than 100 diseases. Of the 16
respondents, 80% experienced dif iculties with
discharge support . Eighty percent of the
respondents indicated that there was a place for
consultation on discharge support, and 40%
indicated that there was no opportunity for learning.
Awareness of the importance of discharge support
was high.
The mean score of the J-NDPAS scale in the NICU
was 13.9±2.0 in the perinatal medical center and14.3±1.4 in the regional perinatal center, and thedischarge practice score was lower in the perinatal
medical center. This was assumed to be related tothe complexity of supporting cases at the Perinatal
Medical Center and the underdeveloped system of
supporting children’s discharge.
There was a signi icant difference in thecharacteristics associated with high and low JNDPAS scores in terms of the opportunity to learn
about discharge support and satisfaction with
discharge support. Furthermore, DPNs require a lotof professional experience to conduct ef icientdischarge planning activities in NICUs.
Recommendations
Further studies on this topic are needed with alarger sample size representing a wider geographicalarea. Although we have identi ied gaps in the current
discharge planning practices of NICU DPNs, to plan
effective interventions and educational
opportunities to ill those gaps, it is important tostudy DPN’s perceptions in depth. Therefore, surveybased and qualitative studies on this topic should be
conducted in the future.
Our study identi ied the most popular dif iculties
among NICU DPNs. However, nurses may have issues
other than the dif iculties mentioned above. Further
studies are needed to identify and clarify thechallenges faced by the DPNs during the dischargeplanning process and when bringing theirperception into real practice in the NICU.
Developing and validating self-evaluating tools for
NICU nurses will help them to ensure quality careand increase nurse satisfaction.
Acknowledgments: We would like to express our sincere
gratitude to all medical institutions for their cooperationin the survey.
Funding: This research was supported by a Grant-in-Aid
for Scienti ic Research on Fundamental Research C from
the Ministry of Education, Culture, Sports, Science andTechnology (MEXT), Japan (2015–2019).
Con lict of Interest: The authors have no con licts ofinterest to declare.

References

Arad I, Netzer D, Haramati Z. The impact of nurses andmothers signing the discharge letter on maternal
knowledge and satisfaction after discharge from aneonatal unit: a before and after study. Int J Nurs Stud.
2007;44(7):1102–8. https://doi.org/10.1016/
j.ijnurstu.2006.04.012

152

Eubios Journal of Asian and International Bioethics 32(5) (September 2022)

f

f

Arroyo M, Rocandio AM, Ansotegui L, et al. Cooperative
learning strategies to teach nutrition to geriatricnursing staff. Arch Latinoam Nutrition.
2008;58(1):27–32. https://www.researchgate.net/
p
u
b
l
i
c
a
t
i
o
n
/
5263195_Cooperative_learning_strategies_to_teach_nu
trition_to_geriatric_nursing_staff
Boamah SA, Spence Laschinger HK, Wong C, et al. Effect oftransformational leadership on job satisfaction andpatient safety outcomes. Nurs Outlook.
2018;66(2):180–9. https://doi.org/10.1016/
j.outlook.2017.10.004
Dellenmark-Blom M, Wigert H. Parents’ experiences withneonatal home care following initial care in the
neonatal intensive care unit: a phenomenologicalhermeneutical interview study. J Adv Nurs.
2014;70(3):575–86. https://doi.org/10.1111/
jan.12218
Domoto T, Takemura Y, Nagata S. Effects of a screening
tool and conferences on nurses’ discharge-planningability in a hospital without a discharge-planningdepartment. Clin Nurs Stud. 2014;2(3):127–39.
https://doi.org/10.5430/cns.v2n3p127
Ekim A, Ocakci AF. Ef icacy of a transition theory-baseddischarge planning program for childhood asthma
management. Int J Nurs Knowl. 2016;27(2):70–8.
https://doi.org/10.1111/2047-3095.12077
Fox M. Nurse-led early discharge planning for chronic
disease reduces hospital readmission rates and allcause mortality. Evid Based Nurs. 2016;19(2):62.
https://doi.org/10.1136/eb-2015-102197
Góes FGB, Cabral IE. Discourses on discharge care forchildren with special healthcare needs. Rev Bras
Enferm. 2017;70(1):154–61. https://doi.org/
10.1590/0034-7167-2016-0248
Gonçalves-Bradley DC, Lannin NA, Clemson LM, et al.
Discharge planning from hospital. Cochrane Database
Syst Rev. 2016;(1):CD000313. https://doi.org/
10.1002/14651858.CD000313.pub5
Graham J, Gallagher R, Bothe J. Nurses’ discharge planningand risk assessment: behaviours, understanding andbarriers. J Clin Nurs. 2013;22(15–16):2338–46.
https://doi.org/10.1111/jocn.12179
Hahn WH, Chang JY, Chang YS, et al. Recent trends inneonatal mortality in very low birth weight Korean
infants: in comparison with Japan and the USA. J
Korean Med Sci. 2011;26(4):467–73. https://doi.org/
10.3346/jkms.2011.26.4.467
Ingram JC, Powell JE, Blair PS, et al. Does family-centred
neonatal discharge planning reduce healthcare usage?
A before and after study in South West England. BMJ
Open. 2016;6(3):e010752. https://doi.org/10.1136/
bmjopen-2015-010752
Kyozuka H, Yasuda S, Kawamura M, et al. Impact of theGreat East Japan Earthquake on feeding methods andnewborn growth at 1 month postpartum: results fromthe Fukushima Health Management Survey. Radiat
Environ Biophys. 2016;55(2):139–46. https://doi.org/
10.1007/s00411-016-0636-7
Lin CJ, Cheng SJ, Shih SC, et al. Discharge planning. Int J
Gerontol. 2012;6(4):237–40. https://doi.org/
10.1016/j.ijge.2012.05.001
Nakanishi H, Suenaga H, Uchiyama A, et al. Trends in theneurodevelopmental outcomes among preterm infants
from 2003–2012: a retrospective cohort study inJapan. J Perinatol. 2018;38(7):917–28. https://doi.org/10.1038/s41372-018-0061-7
Nelson EA, Maruish ME, Axler JL. Effects of dischargeplanning and compliance with outpatient

appointments on readmission rates. Psychiatr Serv.
2000;51(7):885–9. https://doi.org/10.1176/
appi.ps.51.7.885
Niigata Prefecture Perinatal Care Network Demand
Information. https://www.niigata-kenko.com/
syusanki/
Purdy IB, Craig JW, Zeanah P. NICU discharge planning andbeyond: recommendations for parent psychosocial
support. J Perinatol. 2015;35(S1): S24–8. https://doi.org/10.1038/jp.2015.146
Shepperd S, Lannin NA, Clemson LM, et al. Dischargeplanning from hospital to home. Cochrane Database
Syst Rev. 2013;(1):CD000313. https://doi.org/
10.1002/14651858.CD000313.pub4.
Smith VC, Young S, Pursley DM, et al. Are families
prepared for discharge from the NICU? J Perinatol.
2009;29(9):623–9. https://doi.org/10.1038/
jp.2009.58
Suzuki S, Nagata S, Zerwekh J, et al. Effects of a multimethod discharge planning educational program for
medical staff nurses. Japan J Nursing Sci.
2012;9(2):201–15. https://doi.org/10.1111/
j.1742-7924.2011.00203.x
Tanaka M. Niigata NICU Inpatient Discharge Adjustment
Guidebook Revised. Niigata Prefectural Government
O f i c e , N i i g a t a C i t y, 2 0 1 5 . h t t p s : / /w w w. p re f . n i i g a t a . l g . j p / s e c / ke n ko /1356813753310.html
Tomura H, Nagata S, Takeuchi A, et al. Discharge planning
nursing practice at Japanese hospitals — comparisonof nationwide survey results for 2010 and 2014. J
Japan Acad Nurs Sci. 2017;37:150–60. https://doi.org/
10.5630/jans.37.150
Tomura H, Nagata S, Murashima S, et al. Development of ascale to evaluate professional discharge planningability among nurses. J Japan Acad Nursing Sci.
2013;33(3):3_3–3_13. https://doi.org/10.5630/
jans.33.3_3
Tsujimura M, Ishigaki K, Yamamoto-Mitani N, et al.
Cultural characteristics of nursing practice in Japan. Int
J Nurs Pract. 2016;22:56–64. https://doi.org/
10.1111/ijn.12440
Volland PJ. Evolution of discharge planning. In Volland PJ(ed.), Discharge Planning: An Interdisciplinary
Approach to Continuity of Care, 3–18, National HealthPublishing, Owings Mills, Maryland, 1988.
Wilson Smith MG, Sachse K, Perry MT. Road to Home
Program: a performance improvement initiative toincrease family and nurse satisfaction with thedischarge education process for newly diagnosed
pediatric oncology patients. J Pediatric Oncology
Nursing. 2018;35(5):368–74. https://doi.org/
10.1177/1043454218767872
Wong EL, Yam CH, Cheung AW, et al. Barriers to effective
discharge planning: a qualitative study investigating
the perspectives of frontline healthcare professionals.
BMC Health Serv Res. 2011;11(1):242. https://doi.org/10.1186/1472-6963-11-242
Zhu QM, Liu J, Hu HY, et al. Effectiveness of nurse-led early
discharge planning programmes for hospital
inpatients with chronic disease or rehabilitationneeds: a systematic review and meta-analysis. J Clin
Nurs. 2015;24(19-20):2993–3005. https://doi.org/
10.1111/jocn.12895

Eubios Journal of Asian and International Bioethics 32(5) (September 2022)

EJAIB
Chief Editor: Darryl R.J. Macer
Associate Editor: Nader Ghotbi
Editorial Board: Akira Akabayashi (Japan),
Sahin Aksoy (Turkey), Martha Marcela
Rodriguez-Alanis (Mexico), Angeles Tan Alora(Philippines), Atsushi Asai (Japan), Alireza
Bagheri (Iran), Gerhold Becker (Germany),
Rhyddhi Chakraborty (India/UK), Shamima
Lasker (Bangladesh), Minakshi Bhardwaj (UK),
Christian Byk (IALES; France), Ken Daniels (New
Zealand), Ole Doering (Germany),
Amarbayasgalan Dorjderem (Mongolia), Hasan
Erbay (Turkey), Soraj Hongladarom (Thailand),Dena Hsin (Taiwan), Rihito Kimura (Japan),
Abby Lippman (Canada), Umar Jenie(Indonesia), Nobuko Yasuhara Macer (Japan),
Masahiro Morioka (Japan), Anwar Nasim(Pakistan), Jing-Bao Nie (China, New Zealand),
Pinit Ratanakul (Thailand), Qiu Ren Zong
(China), Hyakudai Sakamoto (Japan), Sang-yong
S o n g ( Re p u b l i c o f Ko r e a ) , M a r i a d o s s
Selvanayagam (India), Sang-yong Song
(Republic of Korea), Yanguang Wang (China),
Daniel Wikler (USA), Jeong Ro Yoon (Republic ofKorea).
EJAIB adopts and complies with the Committee on Publication
Ethics (COPE) Publication ethics and malpractice policy. Ourpolicy is on the EJAIB website. All potential authors should haveread these guidelines and by submission of an article forpublication you acknowledge that you have complied with thispolicy. Violations will be handled in proportion to the intention
and seriousness of the violation. If there is a con lict of interest
stated by the authors of an article it will be written in the paper.
Registered address of EJAIB: P.O. Box 16 329, Hornby,
Christchurch 8441, New Zealand
Editorial address, and all correspondence to:Prof. Darryl Macer, Ph.D., Hon.D.
President, American University of Sovereign Nations (AUSN),
https://www.ausovereignnations.org
Email: darryl@eubios.info
For forthcoming conferences see:www.eubios.info or www.ausn.info
International Public Health Ambassadors
https://www.ausovereignnations.org/
international_public_health_ambassadors

We are looking forward to meeting you in
person at the ABC22 Conference in Kuala
Lumpur, Malaysia, 15-17 May 2023!

f

f

f

Email to: provost@ausn.info

153

ASIAN BIOETHICSASSOCIATION MEMBERSHIP
2023
and 2023 subscription to Eubios Journalof Asian & International Bioethics (EJAIB)____ I wish to pay my annual membership feesof Asian Bioethics Association (ABA), andreceive the 2023 issues of Eubios Journal of
Asian and International Bioethics (EJAIB) (TheOf icial Journal). Regular Price: U S $ 1 6 0 E u r o
120 ¥18000 (=Credit card price NZ$200)____ I do not require the hard copy of Eubios
Journal of Asian and International Bioethics(EJAIB).
____ I wish to make a reduced contribution andregister as a member of Asian Bioethics
Association I understand that I should besatis ied with Internet access to Eubios Journalof Asian and International Bioethics (EJAIB)<http://eubios.info/EJAIB.htm>.
____ I wish to make a donation to Eubios Ethics
Institute of ____________ Exchange subscription with journal,
newsletter, etc.
(Name_____________________________________________ )____ I agree / ____ do not agree to my namebeing listed on the ABA www site. List ResearchInterests to be included:
Send an E-mail with your address to: E-mail:darryl@eubios.info and the details for bankaccount payment , Paypal or Western Union will
be provided.
Name:
Mailing address:
E-mail:Web site: <http://eubios.info/ABA.htm>