The aim of this article is to explore the practical complexity of accountability in health care by focusing on a particular crisis affecting one NHS trust in the UK, that of insufficient beds to meet demand. It is presented through the eyes of five middle managers with nursing backgrounds. Although the focus is on their words, their expressions of distress and their awareness of conflict, these lead to a commentary highlighting some of the relationships between theory and practice, policy making (...) and implementation, and, in the final analysis, compulsion and choice. The managers seemed to work within four main patterns of provider accountability: public, professional, pecuniary and personal. These four Ps of accountability created incompatibilities in the accountability process, but the conclusion attempts to draw the threads together to suggest a possible way forward. In order to protect confidentiality, pseudonyms are used for the NHS trust and the interviewees, and some personal details have been disguised. (shrink)

The aim of this article is to explore the practical complexity of accountability in health care by focusing on a particular crisis affecting one NHS trust in the UK, that of insufficient beds to meet demand. It is presented through the eyes of five middle managers with nursing backgrounds. Although the focus is on their words, their expressions of distress and their awareness of conflict, these lead to a commentary highlighting some of the relationships between theory and practice, policy making (...) and implementation, and, in the final analysis, compulsion and choice. The managers seemed to work within four main patterns of provider accountability: public, professional, pecuniary and personal. These four Ps of accountability created incompatibilities in the accountability process, but the conclusion attempts to draw the threads together to suggest a possible way forward.In order to protect confidentiality, pseudonyms are used for the NHS trust and the interviewees, and some personal details have been disguised. (shrink)

With the introduction of general management and then of planned markets into the National Health Service (NHS), health care in the UK has gone through a massive amount of change. The effect on those working for the NHS has been ‘challenging’ and often confusing. This paper aims to clarify what is happening by taking an ideological perspective: what ideologies exist, how they are changing and the strategies being used to ensure their survival. Ideologies are basically about power. The relationship between (...) market, managerial and professional ideologies is analysed using charters, codes of conduct and other associated documents. A tentative conclusion is reached that professional ideologies are able to adjust to the overriding market/consumerist ideology. However, the managerial ideology is having difficulty in gaining any real ground against the professional ideology and is having to move strategically by using audit, not just of finance, but also of clinical judgement, to gain power. (shrink)

The term "false memories" has been used to refer to suggestibility experiments in which whole events are apparently confabulated and in media accounts of contested memories of childhood abuse. Since 1992 psychologists have increasingly used the term "false memory" when discussing memory errors for details, such as specific words within word lists. Use of the term to refer to errors in details is a shift in language away from other terms used historically (e.g., "memory intrusions"). We empirically examine this shift (...) in language and discuss implications of the new use of the term "false memories." Use of the term presents serious ethical challenges to the data-interpretation process by encouraging over-generalization and misapplication of research findings on word memory to social issues. (shrink)

Can scientific evidence outstretch what scientists have mentally entertained, or could ever entertain? This article focuses on the plausibility and consequences of an affirmative answer in a special case. Specifically, it discusses how we may treat automated scientific data-gathering systems—especially AI systems used to make predictions or to generate novel theories—from the point of view of confirmation theory. It uses AlphaFold2 as a case study.

(2001). Looking toward the future of clinical trials: The application of communication variables to the recruitment of women into breast cancer clinical trials. World Futures: Vol. 57, Future Trends in Communications Strategies, pp. 599-613.

This case study focuses on Roger Boisjoly's attempt to prevent the launch of the Challenger and subsequent quest to set the record straight despite negative consequences. Boisjoly's experiences before and after the Challenger disaster raise numerous ethical issues that are integral to any explanation of the disaster and applicable to other management situations. Underlying all these issues, however, is the problematic relationship between individual and organizational responsibility. In analyzing this fundamental issue, this paper has two objectives: first, to demonstrate the (...) extent to which the ethical ambiguity that permeates the relationship between individual and organizational responsibility contributed to the Challenger disaster; second, to reclaim the meaning and importance of individual responsibility within the diluting context of large organizations. (shrink)

_The Collected Works of John Stuart Mill_ took thirty years to complete and is acknowledged as the definitive edition of J.S. Mill and as one of the finest works editions ever completed. Mill's contributions to philosophy, economics, and history, and in the roles of scholar, politician and journalist can hardly be overstated and this edition remains the only reliable version of the full range of Mill's writings. Each volume contains extensive notes, a new introduction and an index. Many of the (...) volumes have been unavailable for some time, but the _Works_ are now again available, both as a complete set and as individual volumes. (shrink)

A Copernican revolution heralds a grand renovation of a tradition of knowledge. In science—the discipline from which the concept originates—it aptly connotes a paradigm shift from a previously accepted notion of reality. It is upon this conceptualization that John Dewey wrote: “Kant claimed that he had effected a Copernican revolution in philosophy by treating the world and our knowledge of it from the standpoint of the knowing subject.” For the Enlightenment thinker, traditional philosophy construed a rational system of nature and (...) then borrowed from it the features by which to characterize knowledge. He argued that this “borrowing” of a rational system should not be credited to some outworldy power, but to human reason. Thus, his “revolution” was a shift from theological to human authorship and a placing of the locus of intellect in man as a knowing subject. Kant’s work created a new center in philosophy: that it is the mind that knows by means of an equipment of powers complete within itself and that it merely exercises its capabilities upon an antecedent external material equally complete in itself. (shrink)

Although it is well known in other fields, the concept of “resilience” has not been addressed explicitly by feminist rhetoricians. This collection develops it in readings of rhetorical situations across a range of social contexts and national cultures. Contributors demonstrate that resilience offers an important new conceptual frame for feminist rhetoric, with emphasis on agency, change, and hope in the daily lives of individuals or groups of individuals disempowered by social or material forces. Collectively, these chapters create a robust conception (...) of resilience as a complex rhetorical process, redeeming it from its popular association with individual heroism through an important focus on relationality, community, and an ethics of connection. Resilience, in this volume, is a specifically rhetorical response to complicated forces in individual lives. Through it, Feminist Rhetorical Resilience widens the interpretive space within which rhetoricians can work. (shrink)

Coaching is a systematic and goal-oriented one-on-one intervention by a coach aimed to guide clients in their professional and personal development. Previous research on coaching has demonstrated effects on a number of positive outcomes, including well-being and performance, yet little is known about the processes that underlie these outcomes, such as the type of questions coaches use. Here, we focus on three different types of coaching questions, and aim to uncover their immediate and sustained effects for affect, self-efficacy, and goal-directed (...) outcomes, using a between-subjects experiment. One hundred and eighty-three medical residents and PhD students from various medical centers and healthcare organizations in the Netherlands were recruited to participate in a self-coaching writing exercise, where they followed written instructions rather than interacting with a real coach. All participants were randomly allocated to one of three conditions: either one of two solution-focused coaching conditions or a problem-focused coaching condition. Self-report questionnaires were used to measure key outcomes of coaching, that is positive and negative affect, self-efficacy, goal orientation, action planning and goal attainment. Two follow-up measurements assessed if the effects of the self-coaching exercise led to problem-solving actions within an initial follow-up period of 14 days and a subsequent follow-up period of 10 days. Findings showed that participants experienced more positive affect, less negative affect, and higher approach goal orientation after the solution-focused coaching exercise compared to the problem-focused coaching exercise. In all conditions, goal attainment increased as a consequence of the self-coaching intervention. We discuss the implications of our findings for the science and practice of contemporary coaching. (shrink)

Does asking about trauma history create participant distress? If so, how does it compare with reactions to other personal questions? Do participants consider trauma questions important compared to other personal questions? Using 2 undergraduate samples (Ns = 240 and 277), the authors compared participants' reactions to trauma questions with their reactions to other possibly invasive questions through a self-report survey. Trauma questions caused relatively minimal distress and were perceived as having greater importance and greater cost-benefit ratings compared to other kinds (...) of psychological research in an undergraduate human subjects pool population. These findings suggest that at least some kinds of trauma research appear to pose minimal risk when compared to other minimal risk research topics, and that participants recognize the importance of research about trauma. (shrink)

The plays written about AIDS in the past dozen years form a radical canon establishing gay men as the locus for public attention. These plays have been all but silent in their representation of women with AIDS. This article examines the marginalized women in early plays such as The Normal Heart and As Is, and the women more central to later plays such as The Baltimore Waltz, Before It Hits Home, and Patient A. It foregrounds some of the most problematic (...) issues surrounding the AIDS virus: the perception of women as vectors of disease for men and unborn children, the insistent representation of women as mothers and caregivers, and the denial of patterns of abuse, sexual exploitation, and poverty which contribute to the marginalization of woman and people of color. (shrink)

Members of the Baha'i Faith have been subject to persecution in Iran since the mid‐nineteenth century. Our investigation considers how collective identity among a Pacific Northwest Community has been constructed through the contexts of continued persecution in Iran and the development of religious texts, which helped to define the religious community. The texts found within the Baha'i Faith utilize metaphors of the body to construct religious identity. Many anthropologists have theorized on the usefulness of the body as a unit of (...) study; in addition, recent attention by scholars has illustrated the intersection of the body and religion. A model is developed linking identity, consciousness, the body and experience that explains how collective identity is constructed. When considering the situation of the Baha'i community, this model has proven particularly useful in understanding how geographically disassociated people manage to construct social kinship within the context of religious persecution. In particular, American Baha'is describe the persecution of Baha'is in Iran as a collective experience, especially since the direct experience of persecution is far removed from their everyday living. Preliminary analysis of interviews with an American Baha'i, and an ex‐patriot Iranian Baha'i reveal differences in constructions of identity. (shrink)

Fan culture has grown immensely over the past few years. People are constantly looking up to celebrities and personalities as role models for their fashion, identity, and success. During the stage of adolescence, it is normal for teenagers to admire well- known people and form fan attachments as part of their identity formation. However, this admiration of a specific media figure can be associated with one's personality, cognitive processes, and psychological well-being. Thus, the current study aims to investigate the correlation (...) between celebrity admiration and the self-esteem of 238 Filipino male teenagers. The research instruments, namely Celebrity Attitude Scale (CAS) and Rosenberg Self-Esteem Scale (RSES) were both utilized through google forms. Results have shown high scores on celebrity admiration and the normal range of self-esteem of the participants. Using Pearson’s r correlation coefficient, it was found that celebrity admiration and self-esteem of Filipino male teenagers have a significant relationship that exists in a negative direction. (shrink)

Is there a link between how a firm manages its internal and external stakeholders? More specifically, are firms that give employees stock ownership and more say in running the enterprise more likely to engage with external stakeholders? This study seeks to answer these questions by elaborating on mechanisms that link employees to external stakeholders, such as the community, suppliers, and the environment. It tests these relationships using a sample of 347 private, mostly small-to-medium size firms, which completed a stakeholder impact (...) assessment organized by the non-profit B Lab. The results support the hypotheses that both employee ownership and employee involvement are positively associated with external stakeholder engagement. Further, we found that certification plays a role, as employee ownership contributes to external stakeholder engagement only in certified B Corporations, and not in firms that merely completed the B Lab Impact assessment. Our findings have import for stakeholder engagement frameworks, as we show that there is interplay between internal employee stakeholders and external stakeholders that may be important to overall firm–stakeholder management. (shrink)

Driven by interests in workforce planning and patient safety, a growing body of literature has begun to identify the reality and the prevalence of missed nursing care, also specified as care left undone, rationed care or unfinished care. Empirical studies and conceptual considerations have focused on structural issues such as staffing, as well as on outcome issues – missed care/unfinished care. Philosophical and ethical aspects of unfinished care are largely unexplored. Thus, while internationally studies highlight instances of covert rationing/missed care/care (...) left undone – suggesting that nurses, in certain contexts, are actively engaged in rationing care – in terms of the nursing and nursing ethics literature, there appears to be a dearth of explicit decision-making frameworks within which to consider rationing of nursing care. In reality, the assumption of policy makers and health service managers is that nurses will continue to provide full care – despite reducing staffing levels and increased patient turnover, dependency and complexity of care. Often, it would appear that rationing/missed care/nursing care left undone is a direct response to overwhelming demands on the nursing resource in specific contexts. A discussion of resource allocation and rationing in nursing therefore seems timely. The aim of this discussion paper is to consider the ethical dimension of issues of resource allocation and rationing as they relate to nursing care and the distribution of the nursing resource. (shrink)

The focus of this article is perceptions of elderly patients and nurses regarding patients’ autonomy in nursing practice. Autonomy is empirically defined as having two components: information received/given as a prerequisite and decision making as the action. The results indicated differences between staff and patient perceptions of patient autonomy for both components in all five countries in which this survey was conducted. There were also differences between countries in the perceptions of patients and nurses regarding the frequency with which patients (...) received information from nursing staff or were offered opportunities to make decisions.This is the second of a set of five articles published together in this issue of Nursing Ethics in which the results of this comparative research project are presented. (shrink)

Many of the activities of clinical practice happen to, with or upon vulnerable human beings. For this reason numerous nursing authors draw attention to or claim a significant moral domain in clinical practice. A number of nursing authors also discuss the emotional involvement and/or emotional labour which is often experienced in clinical practice. In this article I explore the importance of emotion for moral perception and moral agency. I suggest that an aspect of being a good nurse is having an (...) emotional sensitivity to other human beings (patients), because this emotional sensitivity allows the nurse to perceive more accurately the context and perspective of the patient. It is thus important to the moral agency of the nurse and to morally sensitive clinical practice. As such education of the emotions should be a feature of the moral education of the nurse. A useful conception of the role of educated emotion in the moral life can be discovered in Aristotelian ethics. (shrink)

This paper situates the moral domain of practice within the context of a particular description of nursing practice – one that sees human interaction at the heart of that practice. Such a description fits not only with professional rhetoric but also with literature from patients and recent empirical work exploring the nature of nursing practice.Martha Levine in her 1977 description of ethics, within the context of nursing practice, indicated that what was important from an ethical perspective was how we interact (...) with each other, with patients and colleagues, on a daily basis. What enables such interaction to display moral sensitivity, insight into patient need, and a focus on the good for the patient? Of relevance when answering this question is the empirical evidence indicating that professional socialization, as a nurse or a doctor, may dull the individual’s moral sense. If this is the case, cognizance needs to be taken of such evidence when identifying theoretical approaches from mainstream ethics that may provide insight and value for nurse education. It is suggested that such insight and value can be gained from a consideration of the work of Aristotle, Murdoch, and Vetlesen. (shrink)

Even a brief consideration of the nature of nursing will indicate that an ethical dimension underlies much, if not all, of nursing practice. It is therefore important that students and practitioners are facilitated in developing an ethical awareness and sensitivity from early in their professional development. This paper argues that Aristotelian virtue theory provides a practice-based focus for health care ethics for a number of reasons. Also, because of his emphasis on the character of the moral agent, and on the (...) importance of perception and emotion in moral decision-making, Aristotelian virtue theory provides a useful supplement to the traditional duty-based approaches to health care ethics analysis, which are increasingly being identified in the literature as having limits to their application within the health care context. (shrink)

This is the twenty-sixth volume in the Library of Living Philosophers, a series founded by Paul A. Schilpp in 1939 and edited by him until 1981, when the editorship was taken over by Lewis E. Hahn. This volume follows the design of previous volumes. As Schilpp conceived this series, every volume would have the following elements: an intellectual autobiography of the philosopher, a series of expository and critical articles written by exponents and opponents of the philosopher's thought, replies to these (...) critics and commentators by the philosopher, and as nearly complete a bibliography of the published work of the philosopher as possible. (shrink)

Are we on the wrong track, in terms of our expectations of a code of practice, professional ethics teaching or the wider field of moral philosophy, in our search for clear answers to the ethical problems that arise in clinical practice; or are we simply wrong in believing that there are always clear answers?This article examines a particular case, an account of which appeared in Nursing Standard at the end of 1996. The conclusion reached is that we are likely to (...) be misguided in assuming that there are always clear, straightforward answers to the ethical problems of clinical practice. However, more than a fleeting acquaintance with the field of ethics may help us to begin to think with greater clarity about what we do and why we do it. The hope is that this might lead to considered, humane practice by design, with the critical understanding and support of our professional peers and employers. (shrink)

It is frequently claimed that nursing is vital to the safe, humane provision of health care and health service to our populations. It is also recognized however, that nursing is a costly health care resource that must be used effectively and efficiently. There is a growing recognition, from within the nursing profession, health care policy makers and society, of the need to analyse the contribution of nursing to health care and its costs. This becomes increasingly pertinent and urgent in a (...) situation, such as that existing in Ireland, where the current financial crisis has lead to public sector employment moratoria, staff cuts and staffing deficits, combined with increased patient expectation, escalating health care costs, and a health care system restructuring and reform agenda. Such factors, increasingly common internationally, make the identification and effective use of the nursing contribution to health care an issue of international importance. This paper seeks to explore the nature of nursing and the function of the nurse within a 21st century health care system, with a focus on the Irish context. However, this analysis fits into and is relevant to the international context and discussion regarding the nursing workforce. This paper uses recent empirical studies exploring the domains of activity and focus of nursing, together with nurses perceptions of their role and work environment, in order to connect those findings with core conceptual questions about the nature and function of nursing. (shrink)

Objectives: Neuroplastic changes that drive recovery of shoulder/elbow function after stroke have been poorly understood. The purpose of this study was to determine the relationship between neuroplastic brain changes related to shoulder/elbow movement control in response to treatment and recovery of arm motor function in chronic stroke survivors.Methods: Twenty-three chronic stroke survivors were treated with 12 weeks of arm rehabilitation. Outcome measures included functional Magnetic Resonance Imaging (fMRI) for the shoulder/elbow components of reach and a skilled motor function test (Arm (...) Motor Abilities Test, AMAT), collected before and after treatment.Results: We observed two patterns of neuroplastic changes that were associated with gains in motor function: decreased or increased task-related brain activation. Those with significantly better motor function at baseline exhibited a decrease in brain activation in response to treatment, evident in the ipsilesional primary motor and contralesional supplementary motor regions; in contrast, those with greater baseline motor impairment, exhibited increased brain activation in response to treatment. There was a linear relationship between greater functional gain (AMAT) and increased activation in bilateral primary motor, contralesional primary and secondary sensory regions, and contralesional lateral premotor area, after adjusting for baseline AMAT, age, and time since stroke.Conclusions: Recovery of functional reach involves recruitment of several contralesional and bilateral primary motor regions. In response to intensive therapy, the direction of functional brain change (i.e., increase or decrease in task-related brain recruitment) for shoulder/elbow reach components depends on baseline level of motor function and may represent either different phases of recovery or different patterns of neuroplasticity that drive functional recovery. (shrink)