Abstract Occupational stress in nursing has attracted considerable attention as a focus for research and as a consequence multiple objects of nurses' stress, or 'stressors', have been identified. This paper puts into question the dominant conceptual and methodological approach to occupational stress in nursing research by both foregrounding the notion of anxiety and juxtaposing it with the notion of 'stress'. It is argued that the notion of 'stress' and the domination of the questionnaire have produced a narrow reading of the (...) topic. Some of the literature on occupational stress/anxiety in nursing is reviewed and our analysis illustrates how the identified objects of stress have a tendency to multiply contingent on the number of studies undertaken. Thus definitive objects of nurses' stress remain elusive. We argue that a return to the notion of 'anxiety' and methodological approaches other than empirical ones can bring both depth and breadth to the consideration of occupational distress in nursing. Further, we argue that the object of 'anxiety' is unconscious, thus unknown, and given this, a more informative approach is to map nurses' response to anxiety, the discursive formations arising out of anxiety, rather than attempt to define those objects of anxiety. (shrink)

It is well established that nursing practice produces considerable anxiety, and it can also give rise to envy and jealousy. While envy in nursing was identified in the literature more than 50 years ago, there remains a paucity of articles addressing either envy or jealousy for nurses. In a recent research study on current experiences of clinical practice, we analysed a fragment of nurses’ speech via Klein's theory of jealousy. The results revealed that the nurses expressed jealousy at the privilege (...) afforded to doctors. We argue that it is important to acknowledge jealousy in nursing practice because it has the potential for ‘spoiling’ effective care delivery and as such, can have detrimental ramifications in the health system. Also, jealousy may keep the nurse from fully focusing on their nursing practice in that it divides the nurse's attention and so limits the nurse's treatment of the patient. Nurses’ jealousy of doctors is a taboo topic in nursing, and yet it warrants serious consideration due to the potential deleterious consequences that can arise when this dynamic is present. (shrink)

The nurses’ relationship to knowledge has been theorised in a variety of different ways, not the least being in relation to medical dominance. In this study, the authors report on one of the findings of a case study into nurses’ anxiety informed by psychoanalytic theory. They argue that the nurse’s subjection to the knowledge of the other health professional, inclusive of the doctor, can be a transference arising in the context of anxiety for the nurse. Grasped by anxiety, the nurse (...) finds their own knowledge insufficient and in this moment can operate a transference to their non‐nursing colleague, who obligingly, responds. This transference is not present in the change‐of‐shift handover report though, when the other’s knowledge is suspect, even open to derision. Thus, this reference to the knowledge of the other is not consistently present in nursing and can be seen to be just one way that nurses organise themselves in relation to anxiety. Therefore, those wanting to break down the medical dominance of the nursing profession might consider other ways nurses might organise themselves in relation to anxiety, so that the political dominance of the other is not reinforced via transference to that other. (shrink)

This paper reports on the findings of a study that considered how anxiety might function to organise nurses’ practice. With reference to psychoanalytic theory this paper analyses field notes taken during a series of nursing change‐of‐shift handovers. The handover practices analysed met all the criteria for a ritual, as understood in psychoanalytic theory, and functioned to alleviate anxiety in the short term while symbolically expressing a forbidden and unknown knowledge. We argue that the handover ritual contained certain prohibitions, yet allowed (...) some expression of the prohibited knowledge in a disguised way. The prohibition concerned how the patient affected the nurse, that is, moved the nurse to love and hate the patient. We argue that this prohibition is expressed, in disguise, via the displacement of affection for the patient onto other nurses and through negative stereotyping of some patients. We also argue that these prohibitions of the handover mirror broader prohibitions within nursing, and thus the rituals of the handover become an expression of how professional prohibitions are enacted in practice. We conclude that the important implicit function of the handover ritual is to keep anxiety at bay, thereby enabling the nurse to commence practice rather than being immobilised by the effect of potentially overwhelming anxiety. (shrink)

It is well established, following Menzies' work, that nursing practice produces considerable anxiety. Like Menzies, we bring a psychoanalytic perspective to a theorization of anxiety in nursing and do so in order to consider nursing practice in the light of psychoanalytic theory, although from a Lacanian perspective. We also draw on Bataille's notion of ‘surplus’. These concepts provide the theoretical framework for a study investigating how some clinical nurses are able to remain in clinical practice rather than leave the profession (...) or seek work at a distance from the bedside. We conducted focus groups and present here an analysis of two fragments of nurses' speech. We found the nurses responded from one of two positions. In the first position, the nurses focus on doctors, complain about the surplus afforded them, and call for it to be eliminated. In this way, the nursing group is similar to other groups, considered by Bataille, who also attempt to get rid of a surplus. However, in the second position, the nurses stay with the surplus, tolerating it as they nurse the patient. This latter position is one where the nurse practises with a focus on the patient rather than being distracted by their dispute over the doctor's privilege. The importance of this paper is in its illustration of two distinct positions from which the nurse can practise: one that is not optimal because the nurse is distracted and the other that is more focused on practice, and thus the nurse is in a position to provide the best care possible to patients. (shrink)

The body of the one deemed mad often remains a sexual body with sexual needs. Mental health services respond to these demands of the body in various ways, including constructing rules around physical movement. In this context, we were interested in how mental health clinicians problematized the sexual needs and practices of residents of a long‐stay mental health rehabilitation facility and how solutions were constructed in relation to the residents’ sexual desires. This paper reports findings from mental health clinicians, as (...) part of a case study where we addressed this question. Mental health clinicians responded to residents’ sexuality from a discourse of risk. The notion of the engagement with each resident as a sexual subject was subordinated to the paternalistic notion of protecting the patient from risk. The resident became an object to be monitored and protected rather than a subject with sexual desire and agency. This paternalism also showed itself in relation to a ‘no‐sex on‐site’ rule that allowed for a shift of risk from the organization to the resident. Residents, rather than having a relatively safe place to have sexual relations, were required to find a place elsewhere, potentially unsafe, outside the facility. (shrink)

The planet’s swiftly growing population coupled with the lack of food security and the degradation of natural resources has caused many demographers to worry about the ramifications of unchecked population growth while many philosophers worry about the ethical issues surrounding the methods of population control. Therefore, I intend to argue a system of encouraging a decrease in personal fertility rate via financial incentives offers a solution that is both viable and not morally reprehensible.

The planet’s swiftly growing population coupled with the lack of food security and the degradation of natural resources has caused many demographers to worry about the ramifications of unchecked population growth while many philosophers worry about the ethical issues surrounding the methods of population control. Therefore, I intend to argue a system of encouraging a decrease in personal fertility rate via financial incentives offers a solution that is both viable and not morally reprehensible.

El chismorreo puede parecer un comportamiento anecdótico en el contexto de una microsociología de la vida cotidiana. Sin embargo, cuando los medios de comunicación lo convierten en un tema masivo y rentable, cabe pensar que el conocimiento que ofrecen de la vida privada o íntima de los otros tiene r..

Stereology is a valuable tool for neuroscientists, allowing them to obtain 3-Dimensional information from 2-Dimensional measurements made on appropriately sampled sections. This 3-D information is invaluable in correlating structural/functional relationships in the pursuit of far greater understanding of the function of the central nervous system. However, in carrying out such measurements, often based on limited data sets, there is a risk of experimenter bias. An important feature of modern design based stereology is to be aware of potential sources of bias (...) and eliminate them during the data collection. With many of the major neuroscience journals now insisting that quantitative data be presented, there is a greater need than ever for neuroscientists to understand the theory and practice behind quantitative methods, such as those offered by stereology. Quantitative Methods in Neuroscience is a cookbook of stereological methods written especially for neuroscientists. It provides clear and accessible advice about when and when not to use stereology. Throughout the book, the emphasis is on practical guidance, rather than discussions and formulae. Written by leading scientists in the field of stereology, with a Foreword by D.C. Sterio, the book will be a valuable introduction to these methods for neuroscientists, and all those involved in development of new drug programmes.Readership: Neuroscientists doing quantitative studies; Scientists involved in drug development; Pathologists. (shrink)

In the past two to three decades health behavior scientists have increasingly emphasized affect-related concepts in their attempts to understand and facilitate change in important health behaviors, such as smoking, eating, physical activity, substance abuse, and sex. This article provides a narrative review of this burgeoning literature, including relevant theory and research on affective response, incidental affect, affect processing, and affectively charged motivation. An integrative dual-processing framework is presented that suggests pathways through which affect-related concepts may interrelate to influence health (...) behavior. (shrink)

El chismorreo puede parecer un comportamiento anecdótico en el contexto de una microsociología de la vida cotidiana. Sin embargo, cuando los medios de comunicación lo convierten en un tema masivo y rentable, cabe pensar que el conocimiento que ofrecen de la vida privada o íntima de los otros tiene relevancia ética y política en la imagen peculiar y ejemplarizante de la humanidad y de la propia comunidad, así como en las opciones axiológicas, con inevitables repercusiones en el prestigio de la (...) democracia. Para indagar este tema, se parte del estudio sobre la actualidad o inactualidad del pensamiento de Plutarco sobre el fisgoneo. Gossip might appear to be an anecdotal type of behavior in the context of the micro-sociology of everyday life. However, since the media have turned it into a profitable mass topic, it might be reasonable to think that the knowledge it provides about the private life of others is ethically and politically relevant for the peculiar and exemplary image of humanity and of the community itself, as well as for axiological options, thus inevitably affecting the prestige of democracy. In order to explore this issue, the article starts out by examining the currency or lack thereof of Plutarch's thoughts on gossip. (shrink)

Social norms – rules governing which behaviours are deemed appropriate or inappropriate within a given community – are typically taken to be uniquely human. Recently, this position has been challenged by a number of philosophers, cognitive scientists, and ethologists, who have suggested that social norms may also be found in certain non-human animal communities. Such claims have elicited considerable scepticism from norm cognition researchers, who doubt that any non-human animals possess the psychological capacities necessary for normative cognition. However, there is (...) little agreement among these researchers about what these psychological prerequisites are. This makes empirical study of animal social norms difficult, since it is not clear what we are looking for and thus what should count as behavioural evidence for the presence (or absence) of social norms in animals. To break this impasse, we offer an approach that moves beyond contested psychological criteria for social norms. This approach is inspired by the animal culture research program, which has made a similar shift away from heavily psychological definitions of ‘culture’ and to become organized around a cluster of more empirically tractable concepts of culture. Here, we propose an analogous set of constructs built around the core notion of a normative regularity, which we define as a socially maintained pattern of behavioural conformity within a community. We suggest methods for studying potential normative regularities in wild and captive primates. We also discuss the broader scientific and philosophical implications of this research program with respect to questions of human uniqueness, animal welfare and conservation. (shrink)

The informed consent process for genetic testing does not commonly address preferences regarding disclosure of results in the event of the patient's death. Adults being tested for familial colorectal cancer were asked whether they want their exome sequencing results disclosed to another person in the event of their death prior to receiving the results. Of 78 participants, 92% designated an individual and 8% declined to. Further research will help refine practices for informed consent.

In March 2013, after reading articles about the questionable marketing styles of Victoria's Secret, targeted especially to younger demographics, Dolive penned an open letter calling for companies to not view girls as objects but as human beings. The letter came out of his desire to instill in his own daughter that love, care, and acceptance should not be based on articles of clothing. The letter was viewed nearly four million times (on his site alone) in about a week-and-a-half, and dozens (...) of other news organizations and publications picked up the story. Dolive was interviewed by national news publications and appeared on CNN and Headline News. The letter was a catalyst for conversations about body image, marketing, and how the church could affect change and confidence in people of all ages. Seeking Imperfection explores these false messages and takes a look at people from the Bible who, despite their flaws, were still able to serve God faithfully. (shrink)

This paper studies the relationship between organizational ethical climate and the forms of organizational citizenship behavior (OCB), including in-role and extra-role behaviors, and examines the mediating effect of employee loyalty. A sample of employees from a traditional Hong Kong-based company was used as a study group. The purpose of this study was to examine the causes and implications of how various ethical work climates affect employee performance. Based on a model proposed by Victor and Cullen, ethical climate is arranged from (...) lower levels to higher levels. The results suggest that lower levels of ethical climate (instrumentality and independence), characterizing a weak relational contract between employee and employer, are associated with negative extra-role behavior. In contrast, higher levels of ethical climate (caring and law-and-code), symbolic of a strong relational contract at work, are associated with positive extra-role behavior. Moreover, normative commitment mediated a positive relationship between caring and identification with the company, whereas attitudinal loyalty mediated the negative relationship between independence and altruism. Implications for future research and practice are discussed. (shrink)

Nursing has a gendered and religious history where ideas of duty and servitude are present and shape its professional identity. The profession also promotes idealized notions of relationships with patients and of professional autonomy both of which are, in practice, highly constrained or even impossible. This paper draws on psychoanalytic concepts in order to reconsider nursing's professional identity. It does this by presenting an analysis of data from two focus group studies involving nurses in England and Australia held between 2010 (...) and 2012. The studies gave rise to data where extremely negative talk about nursing work seemed to produce, or to be expressed with, a high degree of energy, and a particular kind of enjoyment. In our analysis, we focus on the nurses' apparent enjoyment derived from their expression of a position of powerlessness in which they describe themselves as ‘slaves’ or ‘martyrs’ in the health care system. We interpret this as jouissance and suggest that the positions of slave or martyr provide a possible response to what we argue is the impossibility of the nurse's role. We argue that a remnant of a quasi‐religious ethic within the profession makes it acceptable for nurses to talk about self‐sacrifice and powerlessness as part of their working subjectivity. We further argue that this analysis offers a new consideration of the issue of power and professional identity in nursing that goes beyond seeing nurses as simply overpowered by, or engaged in, a gendered power struggle with other professional groups. We suggest that powerlessness and victimhood hold particular attractions and advantages for nurses and are positions that are more available to nurses than to other occupational groups. This research shows how psychoanalytic theory can help produce new insights into the problems and complexity of nursing and extend existing study of the professions. (shrink)

We show that the N₀-categorical structures produced by Hrushovski's predimension construction with a control function fit neatly into Shelah's $SOP_n $ hierarchy: if they are not simple, then they have SOP₃ and NSOP₄. We also show that structures produced without using a control function can be undecidable and have SOP.

Ben Saunders claims that actual consent is not necessary for organ donation due to ‘normative consent’, a concept he borrows from David Estlund. Combining normative consent with Peter Singer's ‘greater moral evil principle’, Saunders argues that it is immoral for an individual to refuse consent to donate his or her organs. If a presumed consent policy were thus adopted, it would be morally legitimate to remove organs from individuals whose wishes concerning donation are not known. This paper disputes Saunders' arguments. (...) First, if death caused by the absence of organ transplant is the operational premise, then, there is nothing of comparable moral precedence under which a person is not obligated to donate. Saunders' use of Singer's principle produces a duty to donate in almost all circumstances. However, this premise is based on a flawed interpretation of cause and effect between organ availability and death. Second, given growing moral and scientific agreement that the organ donors in heart-beating and non-heart-beating procurement protocols are not dead when their organs are surgically removed, it is not at all clear that people have a duty to consent to their lives being taken for their organs. Third, Saunders' claim that there can be good reasons for refusing consent clashes with his claim that there is a moral obligation for everyone to donate their organs. Saunders' argument is more consistent with a conclusion of ‘mandatory consent’. Finally, it is argued that Saunders' policy, if put into place, would be totalitarian in scope and would therefore be inconsistent with the freedom required for a democratic society. (shrink)

This article explores the ethics of migrant marketers in Guangzhou. Data were collected from 357 migrant marketers who lived in Guangzhou. A model of Ethical Action has been developed to test the antecedents and outcomes of the ethical decision-making process. It measured moral intention using four ethical scenarios. The results show that the egoistic schema had a positive effect on their intention to act unethically, while the legislative schema exerted a negative effect. The results confirm that moral intention was a (...) strong predictor of an individual's subsequent actual behavior, and it fully mediated the influence of the legislative schema on actual behavior. This study adds to ethics literature by incorporating the construct of social identity and found a moderating effect between the legislative schema and moral intention. The relationships were stronger for individuals who were lower rather than higher in social identity. Analysis of these results lead to a discussion of the implications for marketing ethics in China. (shrink)

Within the context of global debates about safety and ethics of supporting women to give birth at home, it is important to analyse documents governing midwifery and obstetric practice and influence decision‐making around place of birth. In Australia, the United States and the United Kingdom, relatively small numbers of women choose to give birth at home despite their midwifery colleges' support. In the United States and Australia, the obstetric colleges do not support homebirth and these countries have lower numbers of (...) women who birth at home, compared with the United Kingdom. There are numerous regulatory and industry challenges for midwives attending homebirths. This paper reports on a Foucauldian analysis of Australian obstetric and midwifery colleges' position statements about homebirth, who have conflicting views, with the view to understanding their arguments and underlying assumptions. The documents highlighted tensions between competing discourses of risk and autonomy and differences in academic argument. Opportunities for strengthening their statements are highlighted. The methodology is applicable for future analysis of similar documents governing practice in other countries. (shrink)

The notion of patients’ duties has received periodic scholarly attention but remains overwhelmed by attention to the duties of healthcare professionals. In a previous paper the author argued that patients in publicly funded healthcare systems have a duty to participate in clinical research, arising from their debt to previous patients. Here the author proposes a greatly extended range of patients’ duties grounding their moral force distinctively in the interests of contemporary and future patients, since medical treatment offered to one patient (...) is always liable to be an opportunity cost in terms of medical treatment needed by other patients. This generates both negative and positive duties. Ten duties—enjoining obligations ranging from participation in healthcare schemes to promoting one’s own earliest recovery from illness—are proposed. The characteristics of these duties, including their basis, moral force, extent and enforceability, are considered. They are tested against a range of objections—principled, societal, epistemological and practical—and found to survive. Finally, the paper suggests that these duties could be thought to reinforce a regrettably adversarial characteristic, shared with rights-based approaches, and that a preferable alternative might be sought through the notion of a “virtuous patient” contributing to a problem-solving partnership with the clinician. However, in defining and giving content to that partnership, there is a clear role for most, if not all, of the proposed duties; their value thus extends beyond the adversarial context in which they might first be thought to arise. (shrink)

Three experiments examined the influence of argument length on plausibility judgements, in a category-based induction task. The general results were that when arguments were logically invalid they were considered stronger when they were longer, but for logically valid arguments longer arguments were considered weaker. In Experiments 1a and 1b when participants were forewarned to avoid using length as a cue to judging plausibility, they still did so. Indeed, participants given the opposite instructions did not follow those instructions either. In Experiment (...) 2 arguments came from a reliable or unreliable speaker. This manipulation affected accuracy as well as response bias, but the effects of argument length for both reliable and unreliable speakers replicated Experiments 1a and 1b. The results were analysed using receiver operating characteristic (ROC) curves and modelled using multidimensional signal detection theory (SDT). Implications for models of category-based inductive reasoning, and theories of reasoning more generally, are discussed. (shrink)

Patients participating in the shared benefits of publicly funded health care enjoy the benefits of treatments tested on previous patients. Future patients similarly depend on treatments tested on present patients. Since properly designed research assumes that the treatments being studied are—so far as is known at the outset—equivalent in therapeutic value, no one is clinically disadvantaged merely by taking part in research, provided the research involves administering active treatments to all participants. This paper argues that, because no other practical or (...) moral considerations count decisively against so doing, we could and should oblige patients to agree to receive indicated treatment within the terms of any concurrent research protocols. This ensures their treatment will benefit not only themselves but also future patients through contributing to new knowledge. By analogy with the paying of income tax, patients should not be allowed to “veto” their social responsibility to take part in clinical research. (shrink)

Terminally ill patients in 10 states plus Washington, D.C. have the right to take prescribed medications to end their lives (medical aid in dying). But otherwise-eligible patients with neuromuscular disabilities (ALS and other illnesses) are excluded if they are physically unable to “self-administer” the medications without assistance. This exclusion is incompatible with disability rights laws that mandate assistance to provide equal access to health care. This contradiction between aid-in-dying laws and disability rights laws can force patients and clinicians into violating (...) one or the other, potentially creating an underclass of patients denied medical care that is available to those with other (less physically disabling) terminal illnesses. The immediacy of this issue is demonstrated by a lawsuit in Federal court filed in August 2021, requesting assistance in self-administration for terminally ill patients with neuromuscular diseases. This paper discusses the background of this conflict, the ethical issues at the heart of the dilemma, and recommends potential remedies. (shrink)

Growing literature has linked attention bias variability to the experience and treatment of posttraumatic stress disorder. Unlike assessments of attention bias in only one direction, A...

Curbside ethics consultations occur when an ethics consultant provides guidance to a party who seeks assistance over ethical concerns in a case, without the consultant involving other stakeholders, conducting his or her own comprehensive review of the case, or writing a chart note. Some have argued that curbside consultation is problematic because the consultant, in focusing on a single narrative offered by the party seeking advice, necessarily fails to account for the full range of moral perspectives. Their concern is that (...) any guidance offered by the ethics consultant will privilege and empower one party’s viewpoint over—and to the exclusion of—other stakeholders. This could lead to serious harms, such as the ethicist being reduced to a means to an end for a clinician seeking to achieve his or her own preferred outcome, the ethicist denying the broader array of stakeholders input in the process, or the ethicist providing wrongheaded or biased advice, posing dangers to the ethical quality of decision-making. Although these concerns are important and must be addressed, we suggest that they are manageable. This paper proposes using conflict coaching, a practice developed within the discipline of conflict management, to mitigate the risks posed by curbside consultation, and thereby create new “spaces” for moral discourse in the care of patients. Thinking of curbside consultations as an opportunity for “clinical ethics conflict coaching” can more fully integrate ethics committee members into the daily ethics of patient care and reduce the frequency of ethically harmful outcomes. (shrink)

Using a fictional but representative general practice consultation, involving the diagnosis of irritable bowel syndrome in a patient who is anxious for some relief from the discomfort his condition entails, this paper argues that when both a drug fails to out-perform placebo and the condition in question is a functional illness with no demonstrable underlying pathology, then the action of the drug is not only no better than placebo, and it is also no different from it either. The paper also (...) argues that, in the circumstances of the consultation described, it is striking that current governance deems it ethical for a practitioner to prescribe either a drug or a placebo, both of which appear to rely for their effectiveness on a measure of concealment on the part of the doctor, yet deems it unethical for a practitioner openly to prescribe a harmless and enjoyable substance which is likely to be no less effective than either drug or placebo and is also likely to be better-tolerated and cheaper than the drug. (shrink)