Background Nurses providing care to patients with end-of-life or terminal illnesses often encounter ethically challenging situations leading to moral distress. However, existing quantitative studies have examined moral distress using instruments that address general clinical situations rather than those specific to end-of-life care. Furthermore, qualitative studies have often been limited to participants from a single unit or those experiencing moral distress-induced circumstances. A comprehensive and integrated understanding of the overarching process of moral distress is vital to discern the unique circumstances surrounding (...) end-of-life care and its consequential impacts. Research objectives To explore the moral distress experiences of nurses who are frequently involved in caring for patients with end-of-life or terminal illnesses and apply it to two existing theories: the model of moral distress and the ecological model. Research design A qualitative descriptive approach was employed. Participants and research context Seven focus group interviews involving 30 nurses were performed. The subsequent transcriptions underwent rigorous content analysis. Ethical considerations We obtained Institutional Review Board approval from a university. Focus group interviews were conducted with nurses who agreed to participate and signed the consent form. Findings The moral distress-inducing factors and nurses’ perceived impact of moral distress were identified and categorized based on moral distress theories and ecological models. A total of 15 categories and 30 subcategories across the following 4 domains were derived: (1) intrapersonal, (2) interpersonal, (3) organizational, and (4) structural factors. Conclusions End-of-life-specific circumstances induced moral distress among nurses, with both negative and positive impacts identified. Effective organizational and policy support is essential to manage conflicts, form a healthy organizational culture, provide training, and prevent unnecessary expenses due to the negative consequences of moral distress. (shrink)

Halal means permissible or lawful in Arabic and is applied to both the religious and daily life of Muslims. Islamic Law Shariah requires Muslims to consume halal products only. But with the expansion of supply chains around the world and the development of many new products, Muslim consumers have found it difficult to confirm whether food is halal or not. Also, as many foods are produced in non-Muslim countries and exported to Muslim countries, interest in halal certification in non-Muslim countries (...) is increasing. With several Islamic countries strengthening their halal certification regulation for import in recent years, there is no accurate information on whether halal certification is necessary to export to Muslim countries or the Islamic State, and is lack of clear study of the definition of the Islamic State. Therefore, in this research, we will investigate the constitution and food import regulations of the Organization for Islamic Cooperation member states, called the Union of Islamic States, to study the definition of Islamic State and whether halal certification is necessary for food exports. (shrink)

The study aimed to examine the influence of personal characteristics on activity preferences using decision tree analysis and examine the effects of the variables using conventional approaches. A descriptive study was conducted with 251 nursing home residents with dementia in Korea to examine the relationship between their personal characteristics and activity preferences. Decision tree analysis was used to classify participants’ activity preferences, and preference levels were examined using logistic regression analysis. Activities were classified as either physical and social activities or (...) cognitive and affective activities. This model showed an accuracy rate of 85.7% for positively predicting physical and social activity preference and 30.3% for positively predicting cognitive and affective activity preference. Gender was the strongest determinant of activity preference. The odds of preferring physical and social activities were 3.179 times higher among women, while the odds for preferring cognitive and affective activities were 0.412 times higher among men. Notably, cognitive and affective activity preference increased to 58.8% for married male participants. This study’s findings can contribute to the development of programs to decrease behavioral and psychological symptoms among older people with dementia residing in nursing homes and provide scientific evidence for integrating these activities into long-term services for this population. (shrink)

Background:Academic ethical awareness is an important aspect especially for nursing students who will provide ethical nursing care to patients in future or try to tread the path of learning toward professional acknowledgement in nursing scholarship.Purpose:The purpose of this study was to explore academic ethical awareness and its related characteristics among undergraduate nursing students.Methods:This study commenced the survey with cross-sectional, descriptive questions and enrolled convenient samples of 581 undergraduate nursing students from three universities in South Korea. It was investigated with structured (...) questionnaires including general characteristics and academic ethical awareness related.Ethical considerations:This study was reviewed and approved by the Institutional Review Board at National University.Findings:Academic ethical awareness was the highest regarding behaviors violating the respect or confidentiality of patients and cheating on exams, while it was the lowest for inappropriate behaviors in class. From the result of general characteristics difference, male students showed higher score than female students in relative; first-year students showed higher score than other year students; the higher score was rated from students who were highly satisfied with their major than the other not satisfied with their major; and students with low academic stress showed higher ethical awareness score than persons with higher stress.Conclusion:Personal behaviors were rated with low ethical awareness in relative, but items related to public rules and actual effects on patients or others were rated with higher score. Nursing satisfaction and academic stress are main factors on ethical awareness. To improve overall ethical awareness level of nursing students, it is required to provide more education about the importance of personal behaviors in class and need to improve the understanding of how it will be connected with future situation and effect. (shrink)

As the COVID-19 pandemic continues to disrupt our lives in unimagined ways, families are reinventing daily rituals, and this is likely true for musical rituals. This study explored how parents with young children used recorded music in their everyday lives during the pandemic. Mothers of child aged 18 months to 5 years living in the United States played the role of home DJ over a period of one week by strategically crafting the sonic home environment, based on resources provided by (...) the authors, in response to their children’s mood and state. Using a newly developed data collection tool, inspired by the Experience Sampling Method, a total of 197 episodes were collected about children’s engagement with recorded music. Findings showed that while mothers utilized music to fulfill various emotional needs, they tended to use it to maintain or reinforce their child’s positive mood rather than to improve a negative mood. Also, mothers’ reports suggested various ways that young children engaged with music, being aligned with the multimodal nature of their musical experiences. Lastly, mothers reported that their strategic approaches to use recorded music seemed to help their children feel less distressed and happier, and this, in turn, aided in the reduction of some of the burdens associated with parenting. (shrink)

For any inquiry into Tasan (茶山)'s philosophy, it is absolutely necessary to investigate its relationship with Neo-Confucianism. Out of the many notions of his philosophy, the Kung-fu theory (工夫論) is considered to be important. Therefore, the comparison between Chu-hui 's (朱熹) system of Neo-Confucianism and Tasan's theory on Kung-fu is expected to offer clues that help us understand Tasan's philosophy. The purpose of this paper is to investigate Tasan’s viewpoints on the notion of ‘having not yet arisen,’ especially in regards (...) to his issues of 'the mind, intelligence, consideration, and discretion (心知思慮),' as presented in his Kung-fu theory. Tasan insists that the statement that "The joy, anger, sorrow, and pleasure have not yet arisen." differs from the statement that "The mind, intelligence, consideration, and discretion (心知思慮) have not yet arisen." In this paper, the author will inquire into Tasan's assertions on the meaning, contents, subject, and significance of ‘the mind, intelligence, consideration, and discretion,’ which he emphasizes. In addition, the author will make clear that the above assertion is related to the following: 1) Tasan’s recognition of Cheon (天), 2) his assertion on the capability of the mind to make decisions by itself (心自主權), and 3) his emphasis on the actualization of morality. (shrink)

This is a comparative study of the discourses on the nature of sacred language found in Indian Abhidharma texts and their counterparts by seventh century Chinese Buddhist scholars who, unlike the Indian Buddhists, questioned "the essence of the Buddha's teaching," and developed intellectual dialogues through their texts. ;In the Indian Abhidharma texts, Sa ngitiparyaya, Jnanaprasthana, Mahavibhasa, Abhidharmakosa, and Nyayanusara, the nature of the Buddha's word was either "sound," the oral component of speech, or "name," the component of language that conveys (...) meaning, or both. I show that the Sautrantikas refused to accept the category of "name," which was abstract and hypothetical to them. However, the attitude of the opposing Sarvastivadins, attested in the Mahavibhasa, for whom "name" was approved in their ontological structure, was ambivalent. In the Abhidharmakosa, both positions were introduced without commentary. Sanghabhadra, an ardent Sarvastivadin, was the only one who explicitly claimed that "name" should be the nature of the Buddha's word. ;What was mainly a linguistic debate in India became transformed in China into a religious and metaphysical one. Chiao-t'i, "the essence of the Buddha's word," was used for the first time by Hsuan-tsang for buddhavacana, "the word of the Buddha" in Sanskrit. Adding the term "essence" altered the nature of the debate. Wonch'uk was the first to view the issue from the broad perspective of its history and provenance in the Indian Buddhist texts. K'uei-chi incorporated it into Yogacara: the Buddha's teaching is what is represented in sentient beings' minds. Fa-tsang defined the essence of the Buddha's teaching as the truth appearing in the mind of the Buddha, which he equated with the truth of the Hua-yen world, tathata. This gradual but candid process of dialogue on "the Buddha's word" preluded a transition to "Chinese" Buddhism. An inquiry no longer in the category of language or of epistemological investigation claims its own identity in the Chinese discussion querying the "essence" or "substance" of the Buddha's teaching, and even "Buddhism" itself, transcending the distinction between language and meaning. (shrink)

This paper outlines Wŏnhyo’s theory of the One Mind as it is presented in his over 20 extant works. According to Wŏnhyo, the One Mind manifests itself in two aspects: “true-thusness” and “arising-a...

This paper outlines Wŏnhyo’s theory of the One Mind as it is presented in his over 20 extant works. According to Wŏnhyo, the One Mind manifests itself in two aspects: “true-thusness” and “arising-a...

BackgroundThe Life Extension Medical Decision law enacted on February 4, 2018 in South Korea was the first to consider the suspension of futile life-sustaining treatment, and its enactment caused a big controversy in Korean society. However, no study has evaluated whether the actual implementation of life-sustaining treatment has decreased after the enforcement of this law. This study aimed to compare the provision of patient consent before and after the enforcement of this law among cancer patients who visited a tertiary university (...) hospital's emergency room to understand the effects of this law on the clinical care of cancer patients.MethodsThis retrospective single cohort study included advanced cancer patients aged over 19 years who visited the emergency room of a tertiary university hospital. The two study periods were as follows: from February 2017 to January 2018 (before) and from May 2018 to April 2019 (after). The primary outcome was the length of hospital stay. The consent rates to perform cardiopulmonary resuscitation (CPR), intubation, continuous renal replacement therapy (CRRT), and intensive care unit (ICU) admission were the secondary outcomes.ResultsThe length of hospital stay decreased after the law was enforced from 4 to 2 days (p = 0.001). The rates of direct transfers to secondary hospitals and nursing hospitals increased from 8.2 to 21.2% (p = 0.001) and from 1.0 to 9.7%, respectively (p < 0.001). The consent rate for admission to the ICU decreased from 6.7 to 2.3% (p = 0.032). For CPR and CRRT, the consent rates decreased from 1.0 to 0.0% and from 13.9 to 8.8%, respectively, but the differences were not significant (p = 0.226 and p = 0.109, respectively).ConclusionAfter the enforcement of the Life Extension Medical Decision law, the length of stay in the tertiary university hospital decreased in patients who established their life-sustaining treatment plans in the emergency room. Moreover, the rate of consent for ICU admission decreased. (shrink)

Background Participants' understanding of clinical trials is important in informed consent. However, little is known about what information participants really want to know. Aims To demonstrate the existence of a discrepancy between participants' understanding and their desire to know. Methods The participants in clinical trials at Seoul National University Hospital were surveyed. The survey consisted of 11 statements based on the essential elements of informed consent. The participants gave two responses to each statement on a five-point Likert scale to rate (...) their subjective understanding and desire to know, respectively. Information discrepancy was defined as the difference between these two ratings: if understanding exceeded desire to know for a particular item, it was defined as ‘over-informed’; if desire to know exceeded understanding for a particular item, it was defined as ‘under-informed’. Results Participants reported good understanding of ‘voluntariness’, ‘duration’, ‘study involves research’ and poor understanding of ‘confidentiality’, ‘compensation’, ‘benefits’, ‘procedures’ and ‘risks or discomforts’. For ‘risks or discomforts’, ‘who to contact’, ‘voluntariness’, ‘duration’ and ‘procedures’, participants reported high desire to know compared with ‘confidentiality’, ‘purpose’, ‘study involves research’ and ‘benefits’. The elements ‘study involves research’, ‘voluntariness’, ‘duration’, ‘purpose’ and ‘who to contact’ were over-informed, while ‘compensation’, ‘risks or discomforts’, ‘procedures’, ‘confidentiality’ and ‘benefits’ were under-informed. Participants over 50 years of age, those without a college education and those whose participation was less voluntary were relatively less informed about the clinical trials. Conclusions An information discrepancy was observed between the participants' understanding and their desire to know. By putting more emphasis on under-informed elements, the quality of informed consent could be improved. (shrink)

With the growing amount of clinical research, regulations and research ethics are becoming more stringent. This trend introduces a need for quality assurance measures for ensuring adherence to research ethics and human research protection beyond Institutional Review Board approval. Audits, one of the most effective tools for assessing quality assurance, are measures used to evaluate Good Clinical Practice and protocol compliance in clinical research. However, they are laborious, time consuming, and require expertise. Therefore, we developed a simple auditing process and (...) evaluated its feasibility and effectiveness. The screening audit was developed using a routine audit checklist based on the Severance Hospital’s Human Research Protection Program policies and procedures. The measure includes 20 questions, and results are summarized in five categories of audit findings. We analyzed 462 studies that were reviewed by the Severance Hospital Human Research Protection Center between 2013 and 2017. We retrospectively analyzed research characteristics, reply rate, audit findings, associated factors and post-screening audit compliance, etc. Investigator reply rates gradually increased, except for the first year. The studies were graded as “critical,” “major,” “minor,” and “not a finding”, based on findings and number of deficiencies. The auditors’ decisions showed fair agreement with weighted kappa values of 0.316, 0.339, and 0.373. Low-risk level studies, single center studies, and non-phase clinical research showed more prevalent frequencies of being “major” or “critical”. Inappropriateness of documents, failure to obtain informed consent, inappropriateness of informed consent process, and failure to protect participants’ personal information were associated with higher audit grade. We were able to observe critical GCP violations in the routine internal audit results of post-screening audit compliance checks in “non-responding” and “critical” studies upon applying the screening audit. Our screening audit is a simple and effective way to assess overall GCP compliance by institutions and to ensure medical ethics. The tool also provides useful selection criteria for conducting routine audits. (shrink)

Modern schooling in Korea, which was officially established by law in 1949, is well known for its function as an engine of economic success in modern Korea. Although this fact seems to be world-wid...

The expansion of the higher education system and the rationalization of universities in South Korea, while broadly following the global patterns, reflect the characteristics of the national political system. We show the rapid growth of universities and document core organizational changes among universities: the elaboration of faculty performance evaluation rules, the expansion and differentiation of central administrations, and the emergence of engagement in vision statements. These changes, constructing universities as organizational actors, parallel the changes in higher education systems elsewhere. However, (...) the uniqueness of the Korean experience lies with the role of the state as a catalyst guiding the overall direction and the structure and strategy of universities. We discuss the implications of our research for the rationalization of universities in a highly centralized system. (shrink)

Dutch euthanasia legislation states that an act of euthanasia is only permissible if it is based on a voluntary request made in a situation of unbearable suffering to which there are no alternatives.The central question of this article is whether these criteria can be satisfied simultaneously. In an analysis of several (partly overlapping) definitions of voluntariness it is argued that there are circumstances in which this question should be answered negatively.The possible incompatibility of the criteria reveals a tension between different (...) defences of the permissibility of euthanasia. (shrink)

This study examined influential factors of newspaper corporation social responsibility and evaluated corporate social responsibility using a newspaper corporate social responsibility index. Results of this study, which was conducted by survey, showed that arbitrative, essential, and cultural activities were influential factors comprised of newspaper corporate social responsibility. In addition, the findings indicated that higher corporate social responsibility index was not accompanied by Korean newspaper corporations with larger circulations.

Many clinical and psychological constructs are conceptualized to have multivariate higher-order constructs that give rise to multidimensional lower-order traits. Although recent measurement models and computing algorithms can accommodate item response data with a higher-order structure, there are few measurement models and computing techniques that can be employed in the context of complex research synthesis, such as meta-analysis of individual participant data or integrative data analysis. The current study was aimed at modeling complex item responses that can arise when underlying domain-specific, (...) lower-order traits are hierarchically related to multiple higher-order traits for individual participant data from multiple studies. We formulated a multi-group, multivariate higher-order item response theory (HO-IRT) model from a Bayesian perspective and developed a new Markov chain Monte Carlo (MCMC) algorithm to simultaneously estimate the (a) structural parameters of the first- and second-order latent traits across multiple groups and (b) item parameters of the model. Results from a simulation study support the feasibility of the MCMC algorithm. From the analysis of real data, we found that a bivariate HO-IRT model with different correlation/covariance structures for different studies fit the data best, compared to a univariate HO-IRT model or other alternate models with unreasonable assumptions (i.e., the same means and covariances across studies). Although more work is needed to further develop the method and to disseminate it, the multi-group multivariate HO-IRT model holds promise to derive a common metric for individual participant data from multiple studies in research synthesis studies for robust inference and for new discoveries. (shrink)

The history of press freedom in South Korea has been characterized by periods of chaos. The major media companies in Korea have written a history of shame. Since Japanese colonial rule, freedom of the press has been more often restricted than protected by the laws and policies. There have been four main features of press freedom since 1910: severe restriction during the Japanese colonial rule; experiencing freedom with unstable democracy under the American military rule and the First and Second republics; (...) oppression of the military regimes; and the struggle with capital power since the advent of civilian government. Several decades of Japanese colonial rule, American military rule, and military dictators have influenced the Korean society and the media politically, economically, socially and culturally. (shrink)

Enlightened experience (i.e. awakened to the truth) is the most valuable one in most religions including Christianity and Buddhism. As well-known cases of such experience are Apocalypse St. Paul and many Grand Zen masters in Zen Buddhism, it is natural for us to believe that the enlighten is for very talented or speciallytrained ones. However, applying the complexity theory on the structure of enlightenment, based on the power law function, selforganized criticality, phase transition, and emergence, it is clear that the (...) full awakening can be experienced by everyone in daily life. Furthermore, such experiences are not necessary to be limited in religious one. Rediscovering the path to full awakening by complexity theory leads to the demythologization of the enlightenment in Korean Zen Buddhism, which emphasizes a hard apprenticeship in temple for long periods for the purpose. (shrink)

A hard choice is a situation in which an agent is unable to make a justifiable choice from a given menu of alternatives. Our objective is to present a systematic treatment of the axiomatic structure of such situations. To do so, we draw on and contribute to the study of choice functions that can be indecisive, i.e., that may fail to select a non-empty set for some menus. In this more general framework, we present new characterizations of two well-known choice (...) rules, the maximally dominant choice rule and the top-cycle choice rule. Together with existing results, this yields an understanding of the circumstances in which hard choices arise. (shrink)

The zone of proximal development is defined as an overarching concept that integrates the main tenets of Vygotsky’s theory of human development. The conceptualization of the ZPD begins with its social, cultural, and historical context and traces its development as a spatial and temporal metaphor that reflects the sociogenetic root of all human mental functioning. Beyond the explication of sociogenesis, the ZPD is reconceptualized to include the notions of voice and dialogicality. The insights gained from the fields of semiotics and (...) discourse studies allow a broader understanding of the ZPD by bringing to light participant structures and institutional and historical forces that may not have been included in the dominant interpretations of the ZPD. (shrink)

Amsterdam University Press is a leading publisher of academic books, journals and textbooks in the Humanities and Social Sciences. Our aim is to make current research available to scholars, students, innovators, and the general public. AUP stands for scholarly excellence, global presence, and engagement with the international academic community.

This paper argues that the philosophical analysis of moral responsibility would benefit from focusing more on the social freedom of individuals. In a critique of Frankfurt, it is argued that an individual only is responsible for the consequences of her action if she had the opportunity not be responsible for them. The resulting theory of moral responsibility is applied to the analysis of collective decision processes, and in particular to political decision making. The main conclusion is that, though we do (...) not bear ‘absolute responsibility’ for all of the consequences of our actions, our moral and political responsibility is larger than often is assumed. (shrink)

Matti Eklund (2017) has argued that ardent realists face a serious dilemma. Ardent realists believe that there is a mind-independent fact as to which normative concepts we are to use. Eklund claims that the ardent realist cannot explain why this is so without plumping in favor of their own normative concepts or changing the topic. The paper first advances the discussion by clarifying two ways of understanding the question of which normative concepts to choose: a theoretical question about which concepts (...) have the abstract property of being normatively privileged and a further practical question of which concepts we are to choose even granting some concepts are thus privileged. I argue that the ardent realist’s best bet for answering the theoretical question while avoiding Eklund’s dilemma is to provide a real definition of this property. I point out the difficulties for providing such a definition. I then argue that even with an answer to the theoretical question, the ardent realist faces a further dilemma in answering the practical question. In sum, though I see no knock-down argument against ardent realism, it may nonetheless die a death by a thousand cuts. I close by considering a deeper reason for why ardent realism is so difficult to defend: every argument starts somewhere. It is unclear how there can be an Archimedean point that makes no reference to any normative concepts that can nonetheless be employed to convince everyone to adopt ours. I then briefly propose two options for someone still inclined towards realism: (i) accept that our normative concepts are normatively privileged without attempting to explain why this is so, or (ii) be less ardent and accept a perspective-dependent account of normativity. (shrink)

The study reviewed 20 currently-available structured ethical decision-making models and developed an integrated model consisting of six steps with useful questions and tools that help better performance each step: (1) the identification of an ethical problem; (2) the collection of additional information to identify the problem and develop solutions; (3) the development of alternatives for analysis and comparison; (4) the selection of the best alternatives and justification; (5) the development of diverse, practical ways to implement ethical decisions and actions; and (...) (6) the evaluation of effects and development of strategies to prevent a similar occurrence. From a pilot-test of the model, nursing students reported positive experiences, including being satisfied with having access to a comprehensive review process of the ethical aspects of decision making and becoming more confident in their decisions. There is a need for the model to be further tested and refined in both the educational and practical environments. (shrink)

In empiricism, there are only two answers for a question: black or white. Yet, subjective meanings of human behaviours and responses toward health and illness cannot be simply explained with black and white. Gray zones are needed because they are characterized by complexity and require a contextual understanding. In this paper, we present and suggest fuzzy logic as an example of theoretical bases that help transcend the conflicts between objectivity and subjectivity, respect gray zones between black and white answers for (...) questions, and provide a contextual understanding of complex nursing phenomenon. A historical review of fuzzy logic is followed by a definition of fuzzy logic. Then, fuzzy logic is discussed in terms of its compatibility with nursing epistemological views and philosophical thoughts. Fuzzy logic agrees with three categories of epistemological views of nursing, including correspondence, coherence and pragmatism. Fuzzy logic also agrees with four major philosophical thoughts in nursing, including postempiricism, pragmatism, feminism, and postmodernism. Based on the discussion, we propose that fuzzy logic be further explored, used and developed in research and practice in the nursing areas/situations/phenomena that are characterized by complexity, ambiguousness, and vagueness. (shrink)