Increased technological and pharmacological interventions in patient care when patient outcomes are uncertain have been linked to the escalation in moral and ethical dilemmas experienced by health care providers in acute care settings. Health care research has shown that facilities that are able to attract and retain nursing staff in a competitive environment and provide high quality care have the capacity for nurses to process and resolve moral and ethical dilemmas. This article reports on the findings of a systematic review (...) of the empirical literature (1980 — February 2007) on the effects of unresolved moral distress and poor ethical climate on nurse turnover. Articles were sought to answer the review question: Does unresolved moral distress and a poor organizational ethical climate increase nurse turnover? Nine articles met the criteria of the review process. Although the prevailing sentiment was that poor ethical climate and moral distress caused staff turnover, definitive answers to the review question remain elusive because there are limited data that confidently support this statement. (shrink)

This paper focuses on examining the dynamic nature of community supported agriculture (CSA) and the real-world experiences which mark its contours, often making it distinct from the early idealized CSA “model.” Specifically, our study examines the narratives of the farmers of Devon Acres CSA over its duration, in tandem with a survey of recent shareholders in order to understand and explain its evolution. The framework we develop here shows that this CSA is largely characterized by instrumental and functional beliefs and (...) practices, with some elements in the collaborative mode. A key contribution of this research is the development of a framework which helps to highlight the relative fluidity and patchwork quality of CSA participant positions over time. At Devon Acres, the real-world factors and issues influencing CSA evolution are seen to be products of both the local and larger contexts, evident in such areas as shifts in farmer learning and adaptation, differences between beliefs and practices in member volunteer efforts, and changes in farm and resource conditions. With respect to CSA more broadly, we argue that the reality of dominant food system context and site-specific influences on CSA development compels us to rework our attachment to early idealized “model” traits. Expansion in CSA numbers, evidence of adaptation and situated learning, and retention of the local and organic as core traits, speak to the pragmatic yet transformative potential of CSA contribution to food system change. (shrink)