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This paper describes the development of a software program that supports argumentative reading and writing, especially for novice students. The software helps readers create a graphic organizer from the text as a knowledge map while they are reading and use their prior knowledge to build their own opinion as new information while they think about writing their essays. Readers using this software can read a text, underline important words or sentences, pick up and dynamically cite the underlined portions of the text onto a knowledge map as quotation nodes, illustrate a knowledge map by linking the nodes, and later write their opinion as an essay while viewing the knowledge map; thus, the software bridges argumentative reading and writing. Sixty-three freshman and sophomore students with no prior argumentative reading and writing education participated in a design case study to evaluate the software in classrooms. Thirty-four students were assigned to a class in which each student developed a knowledge map after underlining and/or highlighting a text with the software, while twenty-nine students were assigned to a class in which they simply wrote their essays after underlining and/or highlighting the text without creating knowledge maps. After receiving an instruction regarding a simplified Toulmin's model followed by instructions for the software usage in argumentative reading and writing along with reading one training text, the students read the target text and developed their essays. The results revealed that students who drew a knowledge map based on the underlining and/or highlighting of the target text developed more argumentative essays than those who did not draw maps. Further analyses revealed that developing knowledge maps fostered an ability to capture the target text's argument, and linking students' ideas to the text's argument directly on the knowledge map helped students develop more constructive essays. Accordingly, we discussed additional necessary scaffolds, such as automatic argument detection and collaborative learning functions, for improving the students' use of appropriate reading and writing strategies.

Background: Moral distress occurs when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action. Moral distress was found to cause negative feelings, burnout, and/or resignation. Not only external factors such as lack of staff but also internal ones affect moral distress. Moral sensitivity, which is thought of as an advantage of nurses, could effect moral distress, as nurses being unaware of existing ethical problems must feel little distress. Objectives: To examine the impact of moral sensitivity on moral distress among psychiatric nurses, and affirm the hypothesis that nurses with higher moral sensitivity will suffer moral distress more than nurses with less moral sensitivity in two different samples. Ethical consideration: The study obtained ethical approval from the Research Ethics Committee of the Faculty of Medicine at Mie University (# 1111, 20.4.2010), and by the Turku University Ethics Board (29.5.2012). Permissions to undertake the study was obtained from the in two hospital districts and in one city (§ 48/4.10.2012, § 63/4.9.2012, 51/2012 27.8.2012). Informed consent was not formally obtained, because the questionnaire was anonymously reported by the participants who volunteered to answer. The participants responded voluntarily and anonymously. Methods: An anonymous questionnaire containing the Revised Moral Sensitivity Questionnaire and the Moral Distress Scale for Psychiatric nurses was conducted to 997 nurses in 12 hospitals in Japan, and 974 nurses in 10 hospitals in Finland after obtaining of approval by research ethics committees. Data were analyzed using a multi-group structural equation model analysis. Findings: A set of analyses imply that the association of moral sensitivity with moral distress is significant and similar between Japan and Finland, whereas the factor structures of moral sensitivity and moral distress may be partially different. Discussion: The result of this study may indicate that nurses with high moral sensitivity can sense and identify moral problems, but not resolve them. Therefore, supporting nurses to solve ethical problems, not benumbing them, can be important for better nursing care and prevention of nurses' resignation. Conclusion: Moral sensitivity and moral distress were positively correlated among psychiatric nurses in both Japan and Finland, although the participating nurses from the two countries were different in qualification, age, and cultural background. Nurses with high moral sensitivity suffer from moral distress. [ABSTRACT FROM AUTHOR]