Increasing globalization of the nursing workforce and the desire for migrants to realize their full potential in their host country is an important public policy and management issue. Several studies have examined the challenges migrant nurses face as they seek licensure and access to international work. However, fewer studies examine the barriers and challenges internationally educated nurses (IEN) experience transitioning into the workforces after they achieve initial registration in their adopted country. In this article, the authors report findings from an (...) empirically grounded study that examines the experience of IENs who entered Ontario’s workforce between 2003 and 2005. We found that migrant nurses unanimously described nursing as ‘different’ from that in their country of origin. Specifically, IENs reported differences in the expectations of professional nursing practice and the role of patients and families in decision‐making. In addition, problems with English language fluency cause work‐related stress and cognitive fatigue. Finally, the experience of being the outsider is a reality for many IENs. This study provides important insights as policy and management decision‐makers balance the tension between increasing the IEN workforce and the delivery of safe patient care. (shrink)

Absence of evidence arguments are indispensable to comparative neurobiology. The absence in a given species of a homologous neural architecture strongly correlated with a type of conscious experience in humans should be able to be taken as a prima facie reason for concluding that the species in question does not have the capacity for that conscious experience. Absence of evidence reasoning is, however, widely disparaged for being both logically illicit and unscientific. This paper argues that these concerns are unwarranted. There (...) is no logical barrier to formulating cogent absence of evidence arguments; indeed, accepting such arguments is part of what it is to be committed to falsifiability as a critical aspect of the scientific method. Absence of evidence arguments can always be blocked, however, by assuming that psychological properties are ‘multiply realizable’. While we take multiple realizability to be highly likely at some level of analysis, we argue that it is question-begging to assume that it exists at every level of analysis, and thus it should not automatically be thought to undermine absence of evidence reasoning in the animal consciousness debate. Using the example of pain and focusing on homologies at the level of information processing tasks, we show how, in the science of consciousness, an absence of evidence might well serve as evidence of absence. (shrink)

Adaptations can occur at different hierarchical levels (e.g., cells and multicellular organisms), but it can be difficult to identify the level(s) of adaptation in specific cases. A major problem is that selection at a lower level can filter up, creating the illusion of selection at a higher level. We use optimality modeling of the volvocine algae to explore the emergence of genuine group (i.e., colony-level) adaptations. We find that it is helpful to develop an explicit model for what group fitness (...) would be in the absence of group-level relationships between traits and group fitness. We call this “counterfactual fitness,” because in many actual cases of interest there are group-level relationships. Once counterfactual fitness is modeled, the difference between effects that filter up and genuine group selection is explicit and so, therefore, is the distinction between apparent and genuine group adaptations. We call the latter group-specific adaptations. Recognizing group-specific adaptations is important because only group-specific adaptations would cause the lower-level units (cells in this case) to be maladapted if they were to leave the group and enter a global cell-level population. Thus, as group-specific adaptations evolve, they create selective pressure for increased cohesiveness and individuality of groups. This article suggests that group-specific adaptations could be present in the simplest, earliest branching colonial volvocine species, which do not have distinct specialized cells. The article also makes predictions about the kind of empirical evidence needed to support or refute the hypothesis that a particular trait is a group-level adaptation. (shrink)

The paper proposes a reflection on mathematical beauty, considering the possibility of aesthetic qualities for formal language. Through a concise overview of the way this question is understood by some famous scientists and mathematicians, we turn our attention to Gian-Carlo Rota’s theoretical proposal: his reflections as a mathematician and philosopher offer a perspective, of phenomenological matrix, fruitful for looking at the question. Rota’s contribution allows us to focus on the role of competence, acquired through effort, sedimentation and habit of repetition, (...) in cultivating the potential to recognise the aesthetic quality of formal language. Finally, we draw on some contributions from Gestalt theory, closely connected to twentieth-century phenomenology for chronological and conceptual reasons, applying the idea of gestalt wholeness to the mathematical product and proposing some reflections that may help to clarify some of the dynamics underlying the attribution of qualities of beauty to formulas or the detection of its lack. (shrink)

Understanding good design requires addressing the question of what units undergo natural selection, thereby becoming adapted. There is, therefore, a natural connection between the formal Darwinism project (which aims to connect population genetics with the evolution of design and fitness maximization) and levels of selection issues. We argue that the formal Darwinism project offers contradictory and confusing lines of thinking concerning level(s) of selection. The project favors multicellular organisms over both the lower (cell) and higher (social group) levels as the (...) level of adaptation. Grafen offers four reasons for giving such special status to multicellular organisms: (1) they lack appreciable within-organism cell selection, (2) they have multiple features that appear contrived for the same purpose, (3) they possess a set of phenotypes, and (4) they leave offspring according to their phenotypes. We discuss why these rationales are not compelling and suggest that a more even-handed approach, in which multicellular organisms are not assumed to have special status, would be desirable for a project that aims to make progress on the foundations of evolutionary theory. (shrink)

We review Evolution and the Levels of Selection by Samir Okasha. This important book provides a cohesive philosophical framework for understanding levels-of-selections problems in biology. Concerning evolutionary transitions, Okasha proposes that three stages characterize the shift from a lower level of selection to a higher one. We discuss the application of Okasha’s three-stage concept to the evolutionary transition from unicellularity to multicellularity in the volvocine green algae. Okasha’s concepts are a provocative step towards a more general understanding of the major (...) evolutionary transitions; however, the application of certain ideas to the volvocine model system is not straightforward. (shrink)

I was dreaming about Delores when the phone interrupted us. It was the Chief, or ‘Stress,’ as we liked to call him, telling me to get part of my anatomy down to Shakey’s Funeral Parlor. My head ached. I thought I must be the only sucker who gets a hangover from being drunk on life. I got up, put two eggs, a spoonful of wheatgerm, the remains of the scotch, and the phonebill into the blender and fed the whole lot (...) to the cat. It helped, but not as much as Delores would have. I should have married her even if she was a Hubot. At least she could play chess. I was still Rumanating over Delores as I hit the curb outside Shakey’s.I had the notion that Shakey’s was once a pizza joint but I could have been wrong. I found Stress, disheveled as usual, in the lobby.‘You’re late,’ he said. I wasn’t, but he’s thatkinda guy. He says ‘Jump!’ and you say ‘With or without my legs?’ We got our free Cokes from Shakey himself, who led us down the hall. (shrink)

Although the role played by narratives and particularly by narratives of personal experience in the construction of identity has been widely investigated, the presence and contribution of such narratives in institutional discourse has received comparatively little attention. Our study focuses on two narratives in university lectures, which show that such narratives are a means of textually constructing not only personal but also professional identities. Analysis reveals that the professors position themselves as experts, exploiting the use of pronouns and other referring (...) expressions in addition to self and other evaluation, in order to distance themselves from non-expert others. In doing so, they make little use of the technical terminology often found in representations of professional selves. In offsetting self-aggrandizement with self-mockery, the professors' narratives display an ideological dilemma typical of the expert in current North American culture, which involves see-sawing between expressions of expertise and equality. (shrink)

This article is concerned with how a particular concept of ontology switched from theistic to atheistic to theistic again due to the influences and disciples of Martin Heidegger. It is agreed that Heidegger took aspects of Christian thought, namely from Augustine of Hippo, Martin Luther, and Søren Kierkegaard, stripping them of their relation to God and instead orientating them to nothingness. Despite Heidegger’s methodological atheism, his ontology was taken up by a number of theologians such as Ernst Fuchs and Rudolf (...) Bultmann, who in their turn influenced Eberhard Jüngel, who in turn mentioned the direct influence that Heidegger has on his thought. Whilst Jüngel acknowledges his debts to Heidegger in the area of ontology, Jüngel also seeks to incorporate the history of God into ontology, where the history of God as Trinity is defined by the passivity of Christ on the cross, and how that event redefines evil’s work in nothingness. This article initially explores how Heidegger formulated his account of ontology, then explores how Jüngel re-Christianized Heidegger’s ontology; evaluating what can be drawn from these shifts about the relationship between ontology and history. (shrink)

Dans cet article, l’auteure, psychologue clinicienne, interroge les enjeux intersubjectifs sous-jacents aux expériences de nourrissage. Elle envisage la croissance psychique comme étant fonction de l’instauration d’une relation humaine intime et nourrissante qu’elle nomme une « relation de nourrissage ». À partir d’une séquence détaillée d’observation de bébé à domicile selon la méthode E. Bick, l’auteure considère la relation de nourrissage comme le paradigme de la rencontre intersubjective. Elle souligne l’importance du travail d’accordage dans la mise en forme et l’intégration de (...) l’expérience. Elle montre ensuite que la relation de nourrissage permet, à travers le rétablissement de l’unité symbiotique postnatale ordinaire, l’accès à une reconnaissance intersubjective individuante. Enfin, elle met en lumière le fantasme organisateur de la relation de nourrissage et le rôle central tenu par la fonction paternelle. (shrink)

The health care industry has moved at a rapid pace away from paper records to an electronic platform across almost all sectors — much of it at the encouragement and insistence of the federal government. Such rapid expansion has increased exponentially the risk to individuals in the privacy of their data and, increasingly, to their physical well-being when medical records are inaccessible through ransomware attacks. Recognizing the unique and critical nature of medical records, the United States Congress established the Health (...) Care Industry Cybersecurity Task Force under the Cybersecurity Information Sharing Act of 2015 for the purpose of reviewing cybersecurity risks within the health care industry and identifying who will lead and coordinate efforts to address such risks among the various agencies. The Task Force has since issued a report setting forth six high-level imperatives that the health care industry needs to achieve in order to combat cybersecurity, and, notably, many of the vulnerabilities plaguing the industry identified in the Report as requiring correction are not necessarily related to specific flaws in the current cybersecurity framework, but rather susceptibilities presented by the infrastructure and associated regulatory regime that has evolved over the last few decades over the health care industry generally. That is, the current health care infrastructure by its nature exacerbates cybersecurity risk. Between a lack of information sharing of industry threats, risks, and mitigations, disparate leadership and governance goals for cybersecurity, the confluence and contradiction of existing federal and state laws, fragmentation in the fee-for-service delivery system, lack of care coordination, and disparate resources across and among sectors, the industry suffers from heightened cyber risk. Solutions that are reactive to problems within the current infrastructure will likely have little long term impact toward reducing cybersecurity vulnerabilities because they do not address the underlying system challenges. All of these confluences causes one to wonder whether if in fact the current health care delivery infrastructure is a contributing factor to the incidents of cybersecurity attacks and the exorbitant costs associated with resolving data breaches, should Congress look not just to curb breach incidents, but to address root cause systematic challenges in the health industry infrastructure that create increased exposure of cybersecurity threats? This article argues that cybersecurity risks will continue to be heightened and more costly to the health care industry as compared to other industries unless and until some general system redesign is achieved that allows for greater sharing of resources among industry participants to ensure the same protections are implemented at all levels of the industry, which can be strengthened through greater interoperability of systems across the health care industry; and increased focus and attention on the importance of cybersecurity issues as a priority among system reforms. (shrink)

Following from life history and attachment theory, individuals are predicted to be sensitive to variation in environmental conditions such that risk and uncertainty are internalized by cognitive, affective, and psychobiological mechanisms. In turn, internalizing of environmental uncertainty is expected to be associated with attitudes toward risk behaviors and investments in education. Native American youth aged 10–19 years (n = 89) from reservation communities participated in a study examining this pathway. Measures included family environmental risk and uncertainty, present and future time (...) perspective, adolescent attachment, attitudes toward risk, investments in education, and salivary cortisol. Results support the idea that environmental risk and uncertainty are internalized during development. In addition, internalizing mechanisms significantly predicted attitudes toward risk and education: (1) lower scores on future time perspective and higher cortisol predicted higher scores on risk attitudes, and (2) higher scores on future time perspective and lower scores on problems with attachment predicted higher self-reported school performance. Gender differences were seen, with males anticipating a shorter lifespan than females, which predicted higher scores on risk attitudes and lower school performance. Implications for research on adolescent problem behavior and academic achievement are discussed. (shrink)

The process of seeking the consent of a patient to a medical procedure is, arguably, one of the most important skills a doctor, or indeed any clinician, should learn. In fact, the very idea that doctors may institute diagnostic or treatment processes of any sort without a patient's consent is utterly counter-intuitive to the modern practice of medicine. It was not always thus, and even now it can be reliably assumed that consent is still not sought and gained appropriately in (...) every clinical encounter. To say that it should be sought and gained in this manner elevates the value of consent to a high level. It can be instructive to ask oneself why such a value might be held to be the case. The answer to this question lies in the philosophical underpinning of clinical consent, which sits within a notion of personal autonomy, and respect for autonomous decision making. (shrink)

Our research addressed an increase of unethical practices in professional settings identified in the literature, and this increase coincides with a shift in U.S. culture from principle-based ethics to one trending toward moral relativism. We discovered many programs lack comprehensiveness to deal with the complexities of culture in graduate education. The purpose of this instrumental case study was to explore and develop a conceptual framework for a comprehensive teaching model targeting graduate-level educators, administrators, and educational boards across disciplines. Data were (...) collected over 13 years from a doctoral professional ethics course at a private, faith-based university in South Texas. Using a Design Based Research process following Reeves’ (2006) guidelines, we developed a multi-disciplinary graduate theoretical teaching model for ethics: Comprehensive Professional Ethics Teaching Model (CPET model), grounded in our data analysis and findings. Recommendations include implementing and testing the efficacy of the CPET model in subsequent studies. (shrink)

Natural ecosystems perform fundamental life-support services upon which human civilization depends. However, many people believe that nature provides these services for free and therefore, they are of little or no value. One nearly forgotten ecosystem service is ecotherapy – the ability of interaction with nature to enhance healing and growth. While we do not pay for this service, we pay significantly for its loss resulting in slower recovery times, greater distress, reduced well-being and losses in those images of nature that (...) contribute to our basic happiness. Little is understood about the ecotherapy benefits of the natural environment and its ecosystem services. The complex and interactive relationship of ecosystems, their services and human well-being is poorly acknowledged in the broad social, philosophical and economic well-being literature. In this article, we examine the role of nature and its ecosystem services in ecotherapy and its associated enhancement of recovery from physical and mental illness. (shrink)

Background Moral distress is a serious problem for health care personnel. Surveys, individual interviews, and focus groups may not capture all of the effects of, and responses to, moral distress. Therefore, we used a new participatory action research approach—moral conflict assessment (MCA)—to characterize moral distress and to facilitate the development of interventions for this problem. Aim To characterize moral distress by analyzing responses of intensive care unit (ICU) personnel who participated in the MCA process. Research Design In this qualitative study, (...) we invited all ICU personnel at 3 urban hospitals to participate in individual or group sessions using the 8-step MCA tool. These sessions were facilitated by either a clinical ethicist or a counseling psychologist who was trained in this process. During each session, one of the researchers took notes and prepared a report for each MCA which were analyzed using qualitative content analysis. Participants and Research Context A total of 24 participants took part in 15 sessions, individually or in groups; 14 were nurses and nurse leaders, 2 were physicians, and 8 were other health professionals. Ethical Considerations This study was approved by the Providence Health Care/University of British Columbia Behavioural Research Ethics Board. Each participant provided written informed consent. Results The main causes of moral distress related to goals of care, communication, teamwork, respect for patient’s preferences, and the managerial system. Suggested solutions included communication strategies and educational activities for health care providers, patients, family members, and others about teamwork, advance directives, and end-of-life care. Participants acknowledged that using the MCA process helped them to reflect on their own thoughts and use their moral agency to turn a distressing situation into a learning and improvement opportunity. Conclusions Using the MCA tool helped participants to characterize their moral distress in a systematic way, and to arrive at new potential solutions. (shrink)

This paper begins by attempting to define midrash as a distinct genre of classical rabbinic literature in order to understand the significance of the term in contemporary discourse. It will then examine what Jewish feminists mean when they apply the term, midrash, to their work and consider the extent to which such appropriation is useful or reasonable. The paper will then outline, with my own suggestions, how midrash might be usefully appropriated for feminist ends and the paper will conclude with (...) a concrete example. (shrink)

When Brentano introduces the notion of immanent objectivity or the intentional inexistence of objects in Psychology from an Empirical Standpoint, he cites Scholastic theories of intentionality and suggests that his own view is continuous with medieval and ancient theories of objective being. Very few philosophers of the middle ages used the terminology of esse objectivuum and those that did, such as Peter Aureol, do not appear to be among the primary Scholastic sources for Brentano’s theory of immanence. To a modern (...) ear moreover talk of things existing in the mind objectively is confusing. But the contrast which is important for understanding Brentano’s theory of intentionality is not that between objectivity and subjectivity as commonly understood nowadays, as if having something objectively in mind excluded its being a subjective phenomenon, but something like Descartes’s opposition between that which objectively exists and that which formally exists. Hence for Descartes, whose characterization of immanent objectivity Brentano often cited approvingly in his lectures, any two thoughts, for example, a thought about God and a thought about a horse, will have exactly the same formal reality but may differ enormously in their degree of objective being. (shrink)

There is a tension within Ockham's theory of mental language between its claim to being a semantics for conventional languages and its claim to being a model of concept acquisition and thought. In particular, the commitment to a redundancy-free mental language which serves to explain important semantic relations such as synonymy and ambiguity conflicts, _prima facie, with the possibility of opaque belief contexts. I argue that it is preferable to treat the theory of mental language as an idealized theory of (...) cognitive competence than to forfeit, as Jerry Fodor does, the commitment to conceptual parsimony. (shrink)

Suppose that one of us were to think as if he was suddenly created and complete but with his view obscured so that he could not see outside. And suppose that he had been so created as if he were moved in the air or the void in such a way that he was not touched by the thickness of the air that he would be able to sense it and as if his limbs were separated so that they did (...) not touch either him or each other. Thence he should see if he would affirm being of his essence. He will not hesitate to affirm himself to exist. He will not however affirm things exterior to his members nor the hidden things of his interiors nor his soul nor his brain nor anything else extrinsic. He will affirm himself to exist though he will not affirm the length or the width or the thickness of himself. If however in that period of time it is possible for him to imagine a hand or another member, that would not be imagined to be part of him nor necessary to his essence. (shrink)

Research indicates that greater involvement in religion may be associated with better physical health. The purpose of this study is to see if the satisfaction of spiritual needs is associated with health. This model that contains the following core hypotheses: Individuals who attend church more often are more likely to receive spiritual support from fellow church members than people who attend worship services less frequently ; receiving more spiritual support is associated with stronger feelings of belonging in a congregation; individuals (...) who feel they belong in their congregations are more likely to feel their spiritual needs have been met; and people who feel their spiritual needs have been met are more likely to rate their health in a favorable manner. The data provide support for each of these relationships. (shrink)