Background Ethical decision-making confidence develops from clinical expertise and is a core competency for nurse leaders. No tool exists to measure confidence levels in nurse leaders based upon an ethical decision-making framework. Aims The objective of this research was to compare ethical decision-making among nurse leaders in the U.S. and three German-speaking countries in Europe by developing and testing a newly constructed Ethical Decision-Making Confidence (EDMC) scale. Methods The cross-sectional survey included 18 theory-derived questions on ethical decision-making confidence which were (...) used to develop the scale. Participants A convenience sample of nurse leaders from the U.S. and three German-speaking countries in Europe who self-identified as holding a leadership position. Ethical Considerations Ethical approval was given by the IRB Board of a U.S. university. Participation in the survey implied voluntary consent. Results The scale’s item structure dimensionality and subscale’s reliability were analyzed and compared between nurse leaders from all four countries. A principal component analysis (PCA) produced a 15-item bi-dimensional EDMC scale yielding a skill-related (9-item) and a behavior-related (6-item) confidence dimension. EDMC subscales showed good-to-excellent internal consistency. In both subscales, U.S. nurse leaders rated their mean EDMC score higher than their German-speaking counterparts in Europe. Discussion This exploratory study is the first of its kind to focus on nurse leaders’ confidence regarding ethical decision-making in an international context. An overarching factor structure was identified, which is shared by the two samples of nurse leaders and to examine (sub)scales’ psychometric properties. Conclusion This newly developed scale is an effective tool for measuring ethical decision-making confidence in nurse leaders. The promising results of this study should be replicated to ensure validity and reliability of the EDMC scale measuring skill-related and behavior-related concepts and include nurse leaders from various cultural, social, and demographic groups. (shrink)

The problem is a simple one. A placebo is “a substance provided to a patient that the physician believes has no specific pharmacological effect upon the condition being treated” (AMA 2007). 1 But i...

Few diagnoses present as great a challenge to one's life as cancer. Many men each year are confronted with a diagnosis of early stage prostate cancer and find themselves making decisions about treatment in the face of side effects that present often devastating effects, including problems controlling one's urine and an inability to perform sexually. In this paper, we explore the narratives of men who, having chosen and undergone treatment for early stage prostate cancer, are living with the consequences. Faced (...) with what Charmaz calls an ‘identity dilemma’, how do these men linguistically construct their identities in the face of challenges to their bodily, personal, and social integrity? Drawing upon theories of social languages and Discourses, we examine how men linguistically resolve the identity dilemmas they encounter and in turn construct an identity in response to a question about the quality of their lives in the face of the adverse event of prostate cancer. We present an analysis of the interview narratives of two men and show how they ‘re-collage’ an identity in the face of fundamental changes in their functioning as men. We argue that these men draw upon alternative discourses to construct themselves as whole, competent, and ‘no less a man'. (shrink)

Industrial wind turbines have been operating in many parts of the globe. Anecdotal reports of perceived adverse health effects relating to industrial wind turbines have been published in the media and on the Internet. Based on these reports, indications were that some residents perceived they were experiencing adverse health effects. The purpose of the WindVOiCe health survey was to provide vigilance monitoring for those wishing to report their perceived adverse health effects. This article discusses the results of a self reporting (...) health survey regarding perceived adverse health effects associated with industrial wind turbines. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Parenting Children With Autism Spectrum Disorders Through the Transition to AdulthoodAnonymous One, Anonymous Two, Lorri Centineo, Anonymous Three, Virginia Clapp, Catherine Cornell, Nancy Coughlin, David McDonald, Mark Osteen, Laura Shumaker, Julie Van der Poel, Anonymous FourMy Son's Life with Autistic Spectrum DisorderAnonymous OneThis is the story of how my son, David, has tried to become independent. David is now 25–years–old. His immediate family is his dad, a brother (...) (age 22) and myself (his mother). He was diagnosed with an autism spectrum disorder (ASD) when he was 13. We looked up all the information and decided not to make a big deal of it. Looking back, he displayed all the classic signs of a high functioning autistic disorder. Would he have been diagnosed with the new DSM 5 guidelines? He probably would have. His life would be much, much different if he had been diagnosed at an early age.I'll start with David at age 13 when he was able to harness his big interest in computer science into a career for himself. He was expelled from middle school for threatening some kid that had been picking on him all year. He had a meltdown and wasn't able to communicate his side of the story and that was it.During the summer of that year he took classes in computer engineering (Microsoft) and became an engineer when he was 13. At that time it was quite an accomplishment because he was the youngest person in the United States to do so at such a young age. (By the way, the administration of the school that expelled him sent him a congratulatory card when he was written up in the paper).His father and uncle are in business running a computer company so David had a ready–made job waiting for him when he graduated from high school and was able to keep it during difficult times. David finished high school (mainstreamed special education as emotionally disturbed) and he also received another engineering certification (Cisco).I have to mention here that I truly did not understand what it was like for my son until one day when he was in high school, as I was lecturing him again for some stupid reason, he said, "You don't know how hard it is for me to not sit in a corner and rock every day." Think about that. ASD individuals get up and keep going every day when they know they are going to be misunderstood and picked on. They all deserve a medal for bravery.David became really upset that he had never had a date and that girls were not even interested in talking to him. He started cutting himself and shaving his head. That got him some attention from the stoner group. He had someone to sit with at lunch anyhow. Parents, I think it's better to have no friends than the wrong friends. They introduced him to drugs.We did not mention any trouble David was having to any relatives. We had lived 800 miles from our families in a very unspoiled part of northern America. In hindsight this was not good either. [End Page 151]Another thing, and I think every parent will agree with this—teachers, school staff, health care industry staff, doctors and every one that comes into contact with an ASD individual—take the time to get to know them. It may be difficult and some may appear non–caring and rude. You must overlook this and look to the person underneath. They are great people. They have been through stuff and it means so much to them. Like I said—parents, you know this. Please remember it when times get tough.During David's senior year he started work release so he could start earning money to buy a car and move out as soon as he turned 18. Things were made easy for David since the company was owned by his father and his uncle and I worked there also. David enjoyed the work but had the occasional meltdown and had difficulties fitting in with other employees. He wasn't able to communicate... (shrink)

This article provides a discussion of the limits of both narrative and culture based on a close textual analysis of the short story, “People Like That Are the Only People Here: Canonical Babbling in Peed Onk,” by Lorrie Moore. In this story, a mother describes her experiences on a pediatric oncology ward when her infant son develops Wilms' tumor. The authors examine how the story satirically portrays the spurious claims of language, story, and culture to protect us from an unjust (...) universe and then exposes their false promises. The various personal, professional, and genre-specific narratives we use to create order and coherence from the terror of serious illness are ultimately ineffective. Similarly, the superficially comforting culture of the hospital ward cares more about creating the illusion of control than it does about the suffering of sick children. Language and culture cannot make sense of human anguish, the article concludes, yet they are all we have to hold back the chaos. Mystery and uncertainty, as part of the human condition, must become part of our stories and part of our culture. (shrink)

In “Moral Luck” Bernard Williams describes a lorry driver who, through no fault of his own, runs over a child, and feels “agent-regret.” I believe that the driver’s feeling is moral since the thought associated with this feeling is a negative moral evaluation of his action. I demonstrate that his action is not morally inadequate with respect his moral obligations. However, I show that his negative evaluation is nevertheless justified since he acted in way that does not live up to (...) his moral values. I then use this distinctive negative moral evaluation to distinguish agent-regret from guilt and mere regret. (shrink)

Bernard Williams described the case of a lorry driver who runs over a child through no fault of his own. In this article, I pursue two aims. First, I want to motivate a puzzle about Williams’s case, which I call the Lorry Driver Paradox and which consists of three individually plausible but jointly inconsistent claims. Second, I want to offer a solution to this paradox based on a novel approach to so-called strict moral answerability. I conclude by responding to the (...) objection that strict answerability is a contradiction in terms. (shrink)

The public transport sector in the urban landscape in Nigeria is a prominent social site for the spatial distribution of automobile graffiti signatures. Transporters have various kinds of symbolic tags on their vehicles that convey different messages which represent their local attitudes, beliefs, religious identities, folk psychology, and safety precautionary measures to recipients (other road users and passers-by). This article, based on two case studies, examines the practice of automobile graffiti on trucks and lorries in Calabar metropolis, Cross River State, (...) south-eastern Nigeria. It investigates the motivations, thematic categories, and subjective semiotic interpretations of these verbal signatures from the perspectives of visual semiotics theory using participant observations, semi-structured interviews, and informal conversations. The study demonstrates that truck drivers/owners use their vehicles as visible artistic platforms in the public space to express their thoughts and sentiments on personal, social, and religious issues affecting the society. The study concludes that these inscriptions and imageries are artistic subcultures that mirror wide ranging value categories and provide outlets for spatial transformation, creative agencies, and social commentaries. (shrink)

This section welcomes submissions addressing literature as a means to explore ethical issues arising in healthcare. “Literature” will be understood broadly, including fiction and creative nonfiction, illness narratives, drama, and poetry; film studies might be considered if the films are adaptations from a literary work. Topics include in-depth analysis of literary works as well as theoretical contributions, discussions, and commentary about narrative approaches to disease and medicine, the way literature shapes the relationship between patients and healthcare professionals, the role of (...) speculative fiction as a testing ground for future scenarios in healthcare, and so on. Articles discussing the uses of literature for bioethics education and outreach will be particularly appreciated. Research on literature not originally written in English will be considered as long as it has also been published in translation. Submissions should include an abstract and should conform to theCQGuidelines for Contributors. To submit an article or discuss a suitable topic, write to Antonio Casado da Rocha [email protected].:This article proposes a concept of narrative autonomy to supplement existing accounts in healthcare ethics. This is done by means of a comparison between three end-of-life scenarios: Tolstoy’sThe Death of Ivan Ilyichand two related contemporary stories by Lorrie Moore and Bernhard Schlink, which explore some problems arising when extremely individualistic notions of patient autonomy are put into practice. It is argued that the best model for palliative care is a cooperative one in which patient autonomy is understood as essentially social, and that involves decisional, executive, informational, and narrative dimensions. (shrink)

Michel Clare est né le 21 février 1927 à Sceaux. Études secondaires, bachelier. Résistance et séjour au Maquis de Lorris à dix-sept ans. Puis sport pour guérir des déceptions d’après la Libération : athlétisme, champion de France du 800 mètres en 1949. De nombreuses fois international. Entre à l’Equipe en 1953 où il occupe les fonctions de grand reporter et spécialiste du ski. Auteur d’un livre sur le Ski (La table ronde). Lauréat de l’Académie des Sports pour une enquête sur (...) les universités américaines et du concours du meilleur article du journalisme sportif. A couvert tous les Jeux olympiques d’hiver et d’été de cette dernière décennie. Collabore, de façon épisodique, à Esprit. (shrink)

The relevance of the research is the intensity of noise emitted by lorries depends on the regime of the vehicle movement. One of the main negative factors caused by road vehicles is air pollution with exhaust gases. The article presents results for noise caused by lorries and gas usage while the vehicle is accelerating. The subject of the study is 4 lorries, and they also feature fuel recording systems which are less than 5 years old. Research methodology. The level of (...) noise emitted by heavyweight transport vehicles is measured according to Lithuanian standard LST ISO 1996-2:2008 requirements. During the tests the noise levels of L A,eq, L C,eq, L C,peak were measured. The tests were done 5 times each and the results are presented as arithmetical averages. Fuel consumption is registered in vehicle data registration system. The researched vehicles have to comply with environmental safety normative requirements; that the vehicle carbon monoxide, particulate matter, nitrogen oxides, unburned fuel and other hazardous substances contained in the combustion gases must not exceed the prescribed limits. The results of the experimental studies show that EURO6 lorries noise level is the lowest compared to the EURO4 and EURO5. After carrying out the analysis of the caused noise and gas usage, it was found that noise pollution and gas usage are higher without speed control system. The noise caused by lorries can be described in square polynomial which defines the noise inclination change while vehicle is accelerating. Scientific novelty of the research a complex research on noise and fuel consumption of lorries by using and not using speed control system. Research idea and problem is to achieve sustainable transport development objectives, in particular the reduction of greenhouse gas emissions under the Kyoto Protocol. It is very important to find ways to forecast and reduce transport noise pollution, while also reducing overall pollution, as well as mitigating the impact on the global climate., Conclusion – after conducting a lorry noise and fuel consumption analysis, it was determined that not using speed control system increases the noise and fuel consumption and if the system is used both of these factors decrease drastically. (shrink)

Dismantling Glorydeals with the poetry written about the honors and horrors of battle by the very soldiers who put their lives on the line. Focusing on American and English poetry from World Wars I and II and the Vietnam War, Lorrie Goldensohn presents the move from a poetry largely bound to trench warfare to a global war poetry dominated by air power, invasion, and occupation. Civilians, prisoners, and children enter this poetry in new and compelling ways, as do issues of (...) race and gender, changing and complicating the representation of war, and expanding the scope of antiwar thinking. (shrink)

This unique book provides an introductory overview of modern theoretical linguistics which manages to be both accessible and humorous without sacrificing either scholarship of insight. In a series of magisterial vignettes Smith emphasizes the perennial necessity of appealing to linguistic theory if we are to gain any real understanding of the phenomena of language. However profound or however trivial the questions we raise and try answer - What exactly does one have to know to count as a speaker of a (...) language? What would it mean for a language to have no vowels? Why do little children call lorries 'lollies'? Precisely what with this sentence is wrong? - we need to recourse to a theory even to make them coherent. In particular, the author argues that we can find solutions to our puzzles, and explanations for these phenomena, if we exploit on the one hand Chomsky's theory of Generative Grammar, and on the other Sperber and Wilson's theory of Relevance. (shrink)