Background:Nurse managers are placed in a unique position within the healthcare system where they greatly impact upon the nursing work environment. Ethical dilemmas and moral distress have been reported for staff nurses but not for nurse middle managers.Objective:To describe ethical dilemmas and moral distress among nurse middle managers arising from situations of ethical conflict.Methods:The Ethical Dilemmas in Nursing–Middle Manager Questionnaire and a personal characteristics questionnaire were administered to a convenience sample of middle managers from four hospitals in Israel.Results:Middle managers report (...) low to moderate levels of frequency and intensity of ethical dilemmas and moral distress. Highest scores were for administrative dilemmas.Conclusion:Middle managers experience lower levels of ethical dilemmas and moral distress than staff nurses, which are irrespective of their personal characteristics. Interventions should be developed, studied, and then incorporated into institutional frameworks in order to improve this situation. (shrink)

Background:Cardio-pulmonary resuscitation is the default procedure during cardio-pulmonary arrest. If a patient does not want cardio-pulmonary resuscitation, then a do not attempt resuscitation order must be documented. Often, this order is not given; even if thought to be appropriate. This situation can lead to a slow code, defined as an ineffective resuscitation, where all resuscitation procedures are not performed or done slowly.Research objectives:To describe the perceptions of nurses working on internal medicine wards of slow codes, including the factors associated with (...) its implementation.Research design:This was a cross-sectional, descriptive study. Participants completed a personal characteristics questionnaire and the Perceptions and Factors of Slow Codes questionnaire designed for this study.Participants and research context:The sample was a convenience sample of nurses working on internal medicine wards in two Israeli hospitals.Ethical considerations:The study received ethical approval from both institutions, where data were collected and stored according to institutional policy.Findings:Most reported that resuscitations were conducted according to protocol. Some took their time calling the code, or waited by the bedside and did not perform cardio-pulmonary resuscitation. Factors most associated with slow codes were poor patient prognosis and a low chance of patient survival. Two-thirds reported that slow codes were done on their unit and the majority perceived slow codes as ethical.Discussion:This study confirms that slow codes are part of medical care on internal medicine wards, where most nurses perceive them as an ethical alternative. These perceptions are in contrast to most legal and ethical opinions expressed in the literature.Conclusion:Nurses should be educated about the legal and ethical implications of slow codes, and qualitative and quantitative studies should be conducted that further investigate its implementation. (shrink)

In this acticle I want to introduce the work of the painter Marlene Dumas. The human condition and religion are important themes in her work. I explore the question if she is a feminist, religious or neither but an artist with just provoking ideas? In my opinion she is in her provoking ideas at the edge of both feminism and religion.

Background and aims. In pediatrics receiving a diagnosis of a chronic condition is a matter that involves caregivers at first. Beyond the basic issues of caring for the physical body of the ill child, caregivers’ manners of facing and making sense of the disease orient and co-construct their children’s sensemaking processes of the disease itself. The aim of this article is to explore the experience of a rare chronic illness, Hereditary Angioedema (HAE), in pediatrics, from the caregivers’ perspective. Hereditary Angioedema (...) is characterized by subcutaneous swellings that can involve the mucosal tissues of external as well as internal parts of the body, manifesting in a highly variable and unpredictable way in terms of localization, severity, and frequency. Materials and methods. Within a qualitatively-driven research design, we conducted a qualitative narrative semiotic analysis of n.28 mothers’ narratives on their children’s disease experience. Narratives were collected by an ad hoc interview on three domains of the disease experience: A. interpretation of the disease variability; B. dialogical processes; C. management of the disease. Subsequently, we executed a TwoStep cluster analysis for categorical data to detect cross-sectional profiles of the maternal sensemaking processes of the disease. Results. The coding grid was built analyzing the characteristic of the narrative links that orient the connection between the elements of the experience within each domain: A. the connection among events, for the domain of the interpretation of the disease variability; B. the connection between self and other, for the domain of the dialogue; C. the connection among sensemaking and actions, for the domain of the management of the disease. Results from cluster analysis show three narrative profiles: 1. adempitive; 2. reactive; 3. dynamic. Discussion. Profiles will be discussed in the light of the general conceptual framework of the Sense of Grip on the Disease (SoGoD) highlighting the importance of those sensemaking processes which, instead of relying on a coherent and close interpretation of the disease, are characterized by a degree of tolerance for the uncertainty and the unknowingly. (shrink)

The authoress questions the historiographic dogma that, tracing back to F.W. Maitland, gave the pure «Englishry» of English law for granted, thus building its history on its exceptionality with respect to European tradition, from which it would not have been contaminated at all. The Anglo-Saxon historiographical analysis of the most important English constitutional document aims at answering to the provocative question: how English is Magna Carta? What role did jus commune play in its drafting? What is its relationship with contemporary (...) Roman Canon law? Through the examination of its cultural roots, the essay shows not only the substantial influence of Roman Canon law on Magna Carta, but also, more generally, the affinities and the common elements that characterize in principle the relationship between English juridical tradition and the continental one. (shrink)

Although generational differences have been studied in developed countires, not much information is available about generational cohorts and how they differ in terms of work ethics in developing countries. A cross-sectional study was conducted with a sample of 301 respondents from South Africa. Work ethics of three generational cohorts were measured, namely the Baby Boomers, Generation X, and Generation Y. The main finding of this research was that statistically significant differences and similarities were found between the various generational cohorts in (...) terms of work ethics facets. Statistically significant generational differences were indicated for hard work and delay of gratification. (shrink)

Editors of scientific literature rely heavily on peer reviewers to evaluate the integrity of research conduct and validity of findings in manuscript submissions. The purpose of this study was to describe the ethical concerns of reviewers of nursing journals. This descriptive cross-sectional study was an anonymous online survey. The findings reported here were part of a larger investigation of experiences of reviewers. Fifty-two editors of nursing journals (six outside the USA) agreed to invite their review panels to participate. A 69-item (...) forced-choice and open-ended survey developed by the authors based on the literature was pilot tested with 18 reviewers before being entered into SurveyMonkeyTM. A total of 1675 reviewers responded with useable surveys. Six questions elicited responses about ethical issues, such as conflict of interest, protection of human research participants, plagiarism, duplicate publication, misrepresentation of data and ‘other’. The reviewers indicated whether they had experienced such a concern and notified the editor, and how satisfied they were with the outcome. They provided specific examples. Approximately 20% of the reviewers had experienced various ethical dilemmas. Although the majority reported their concerns to the editor, not all did so, and not all were satisfied with the outcomes. The most commonly reported concern perceived was inadequate protection of human participants. The least common was plagiarism, but this was most often reported to the editor and least often led to a satisfactory outcome. Qualitative responses at the end of the survey indicate this lack of satisfaction was most commonly related to feedback provided on resolution by the editor. The findings from this study suggest several areas that editors should note, including follow up with reviewers when they identify ethical concerns about a manuscript. (shrink)

Patients with advanced dementia are less likely than those with other terminal illnesses to receive palliative care. Due to the nature and course of dementia, there may be a failure to recognize the terminal stage of the disease. A possible and under-investigated explanation for this healthcare disparity is the healthcare practitioner who plays a primary role in end-of-life decision-making. Two potential areas that might impact provider decision-making are cognitive biases and moral considerations. In this analysis, we demonstrate how the cognitive (...) biases and moral considerations of practitioners related to clinical decision-making are inherent in clinical practice and may impact on providers’ accuracy related to diagnostic and treatment related decision-making associated with patients with advanced dementia. Anchoring, default, availability, representativeness and framing biases are cognitive biases based on the "Two System Model" that relate to decision-making in end-of-life care. In patients with advanced dementia, those biases may result in a tendency to adhere to traditional mandatory care, involving an aggressive approach to care, which values saving lives at all costs, without taking into account the possible suffering and long-term consequences. Aspects such as moral sensitivity and moral courage play an important role in ethical decision-making related to advanced dementia. Investigations of clinical decision-making that include the cognitive biases and ethical considerations of practitioners might advance the comprehensive understanding of the clinical decision-making process related to care of patients with advanced dementia and promote the quality of care given to this population. (shrink)

Academic engagement describes students’ involvement in academic learning and achievement. This paper reports the psychometric properties of the University Student Engagement Inventory (USEI) with a sample of 3992 university students from nine different countries and regions from Europe, North and South America, Africa, and Asia. The USEI operationalizes a trifactorial conceptualization of academic engagement (behavioral, emotional and cognitive). Construct validity was assessed by means of confirmatory factor analysis and reliability was assessed using Cronbach’s alpha and McDonald’s omega coefficients. Weak measurement (...) invariance was observed for country/region, while strong measurement invariance was observed for gender and area of graduation. The USEI scores showed predictive validity for dropout intention, self-rated academic performance, and course approval rate while divergent validity with student burnout scores was also evident. Overall, the results indicate that the USEI can produce reliable and valid data on academic engagement of university students across the world. (shrink)

For the newly trained Cognitive Behavioural Therapist, there are a wealth of challenges and difficulties faced as they try and apply their new found skills in the outside world. These might include the stresses of working in isolation, and finding it difficult to widen their scope or bounce ideas of other CBT therapists; or the need for practical advice on setting up group therapy; the possible conflicts betweens ethical practice and theory; trying to retain ones integrity as a therapist, while (...) maintaing a viable business practice.The Oxford Guide to Surviving CBT Practice is the one-stop resource for the newly trained therapist. It offers practical guidance on a range of issues and challenges faced by the therapist. Written by people with vast experience of training and practising CBT, it draws on real life situations to help the reader hone and develop their skills, adjust to life as a therapist, and maintain a successful and satisfying career whilst helping others.With thousands of new CBT therapists due to be trained over the coming years, this book will be a well thumbed and constant companion for all those starting life as a therapist - one they will want to have to hand at all times. (shrink)

The spread of COVID-19 in Italy resulted in the implementation of a lockdown that obligated the first time the general populace to remain at home for approximately two months. This lockdown interrupted citizens’ professional and educational activities, in addition to closing shops, offices and educational institutions. The resulting changes in people’s daily routines and activities induced unexpected changes in their thoughts, feelings and attitudes, in addition to altering their life perceptions. Consequently, the present study explores how young adults perceived their (...) lives under lockdown during the final week of March 2020, when the reported number of daily coronavirus infections reached its peak in Italy. The research was carried out among 293 university students (234 women and 59 men) with an average age of 20.85 years old (SD = 3.23). The researchers asked participants to describe the emotions, thoughts and experiences that characterized their time under lockdown. The study analyzed specific narratives related to time and space using grounded theory methodology, which was applied using Atlas 8 software, leading to the creation of 68 codes. The study organized these codes into three specific categories: confined in the present, confined in the past, and striving toward one’s goals. Finally, the researchers also created a core-category labeled “continuity of being.” The results showed that the closure of open spaces caused a division in participants’ perceptions of time continuity, with many viewing themselves as feeling fragmented and as living the present in a static and fixed way. Additionally, participants also saw the present as being discontinuous from the past, while, simultaneously, projecting toward the future and the changes it might bring. Finally, this study examined further implications surrounding individual projecting among young people in greater depth. (shrink)

During the COVID-19 outbreak, individuals with or without mental disorders may resort to dysfunctional psychological strategies that could trigger or heighten their emotional distress. The current study aims to explore the links between maladaptive daydreaming, psychological symptoms of depression, anxiety, and negative stress, and COVID-19-related variables, such as changes in face-to-face and online relationships, during the COVID-19 lockdown in Italy. A total of 6,277 Italian adults completed an online survey, including socio-demographic variables, COVID-19 related information, the 16-item Maladaptive Daydreaming Scale, (...) and Depression, Anxiety, and Stress Scales-21 Items. Based on an empirically derived cut-off score, 1,082 participants were identified as probable maladaptive daydreamers. A binary logistic regression revealed that compared to controls, probable MDers reported that during the COVID-19 lockdown they experienced higher levels of anxiety and depression, decreased online social relationships, and, surprisingly, stable or increased face-to-face social relationships. Given the peculiar characteristics of the pandemic context, these findings suggest that the exposure to the risk of contagion had probably exacerbated the tendency of probable MDers to lock themselves inside their mental fantasy worlds, which in turn may have contributed to further estrangement from online social relationships and support, thus worsening their emotional distress. (shrink)

When Wet’suwet’en matriarch Freda Huson declared that ‘reconciliation is dead’ and called on supporters to ‘Shut Down Canada’, activists responded with a nationwide series of blockades and occupations. Many commenters, even those sympathetic to the Wet’suwet’en, rushed to defend the idea of reconciliation. Such responses fail to take the contributions this movement offers to decolonial thought seriously. Drawing on interviews with movement participants, I explore what participants mean by reconciliation and what they intend by declaring it dead, showing how (...) participants reject forms of decolonization that center the needs of the settler state. I also explore Land Back as an emerging, grassroots alternative to reconciliation that centers the resurgence of Indigenous governance systems in place of the settler state. Finally I explore settlers’ place within this project and considers its relation to the resurgence school of thought. (shrink)

This collection demonstrates the strong influence that humanism and freethought had in developing the history and ideals of black intellectualism. Most people are quick to note the profound influence that religion has played in African-American history: consoling the downtrodden slave or inspiring the abolitionists, the underground railroad, and the civil rights movement. But few are aware of the role humanism played in shaping the black experience: developing the thought and motivating the actions of powerful African-American intellectuals. Section One of this (...) book offers biographical sketches of such prominent black humanists as Frederick Douglass, Cheikh Anta Diop, W.E.B. DuBois, Hubert H. Harrison, and Richard Wright. Section Two features essays by black humanists: Douglass, DuBois, Charles W. Faulkner, Langston Hughes, Zora Neale Hurston, Ishmael Jaffree, Claude McKay, Melvin B. Tolson, and Bruce Wright. Section Three offers the views of contemporary black African humanists: Freda Amakye Ansah, Emmanuel Kofi Mensah, Nkeonye Otakpor, Franz Vanderpuye, and Kwasi Wiredu. Section Four contains interviews conducted by Allen on the subjects of black humanist activism, the Afroasiatic roots of classical civilization, and the Harlem Renaissance with: Martin G. Bernal, Charles Faulkner, Leonard Harris, Norman Hill, and Alaine Locke. (shrink)

A book review of a "Psychology in Progress" collection of these early 1980s articles from a variety of cognitive science disciplines that were pushing back against behaviourism, exploring the nature and function of consciousness, &/or advancing (or rediscovering) content-driven or representational models. Book Chapters: Editor's introduction: "Human brain anatomy" Harry J. Jerison, "On the Evolution of mind" Keith Oatley, "Representations of the physical and social world" John O'Keefe, "Is consciousness the gateway to the hippocampal cognitive map? A speculative essay on (...) the neural basis of mind" David A. Oakley, "Cognition and imagery in animals" David A. Oakley, "Animal awareness, consciousness and self-image" Freda Newcome, "Neuropsychology of consciousness: a review of human clinical evidence" Joseph E. LeDoux, "Brain, mind and language" David A. Oakley and Lesley C. Eames, "The plurality of consciousness". (shrink)