This paper describes a practice innovation: the addition of formal weekly discussions of patients with prolonged PICU stay to reduce healthcare providers’ moral distress and decrease length of stay for patients with life-threatening illnesses. We evaluated the innovation using a pre/post intervention design measuring provider moral distress and comparing patient outcomes using retrospective historical controls. Physicians and nurses on staff in our pediatric intensive care unit in a quaternary care children's hospital participated in the evaluation. There were 60 patients in (...) the interventional group and 66 patients in the historical control group. We evaluated the impact of weekly meetings to establish goals of care for patients with longer than 10 days length of stay in the ICU for a year. Moral distress was measured intermittently and reported moral distress thermometer scores fluctuated. "Clinical situations" represented the most frequent contributing factor to moral distress. Post intervention, overall moral distress scores, measured on the moral distress scale revised, were lower for respondents in all categories, and on three specific items. Patient outcomes before and after PEACE intervention showed a statistically significant decrease in PRISM indexed LOS, a statistically significant increase in both code status changes DNR, and in-hospital death, with no change in patient 30 or 365 day mortality. The addition of a clinical ethicist and senior intensivist to weekly inter-professional team meetings facilitated difficult conversations regarding realistic goals of care. The study demonstrated that the PEACE intervention had a positive impact on some factors that contribute to moral distress and can shorten PICU length of stay for some patients. (shrink)

Moral distress is a well-documented phenomenon for health care providers (HCPs). Exploring HCPs’ perceptions of participation in moral distress interventions using qualitative and quantitative methods enhances understanding of intervention effectiveness. The purpose of this study was to measure and describe the impact of a two-phased intervention on participants’ moral distress. Using a cross-over design, the project aimed to determine if the intervention would decrease moral distress, enhance moral agency, and improve perceptions about the work environment. We used quantitative instruments and (...) explored participants’ perceptions of the intervention using semi-structured interviews. Participants were from inpatient settings, within three major hospitals of a large, urban healthcare system in the Midwest, United States. Participants included nurses (80.6%) and other clinical care providers. Using generalized linear mixed modeling we assessed the change in each of the outcome variables over time controlling for groups. Interviews were audiotaped and professionally transcribed. The written narratives were coded into themes. The change in scores on study instruments trended in the desired direction however did not meet statistical significance. Qualitative interviews revealed that intervention effectiveness was derived from a combination of learning benefits, psychological benefits, and building community that promoted moral agency. Findings demonstrate a clear link between moral distress and moral agency and suggest that Facilitated Ethics Conversations can enhance the work environment. Findings provide insight for developing evidenced-based approaches to address moral distress of hospital nurses. (shrink)

Considering Rosmini’s political works in comparison with his metaphysical and anthropological essays, and starting from Rosmini's project of a code of law that, in the author’s opinion, can guarantee fundamental human rights, this article discusses the concept of justice between citizens and outsiders. Its first part is an analysis of Rosmini’s juridical fundaments, which takes into account also some objections historically moved against it. Its second part examines some specific cases of conflicts between outsiders and the members of civil society, (...) as considered by the Roveretan philosopher. (shrink)

Resumen Este artículo intentará contribuir a la discusión teórica y filosófica política sobre la emancipación y la democracia en base a la producción intelectual reciente de Étienne Balibar y Jacques Rancière. Las nociones con las que ambos autores acompañan la idea de emancipación, por una parte, iluminan sobre otros modos posibles de pensar la política, las luchas y la transformación, y, por otra parte, permiten re-significar la filosofía y la política, así como la inclusión de la igualdad radical entre los (...) seres hablantes en el centro de la disputa teórica y política.This article will attempt to contribute to the theoretical and philosophical political discussion on emancipation and democracy based on the recent intellectual production of Étienne Balibar and Jacques Rancière. The notions with which both authors accompany the idea of emancipation, on the one hand, illuminate on other possible ways of thinking about politics, struggles and transformation, and, on the other hand, allow us to re-signify philosophy and politics, thus as the inclusion of radical equality between speaking beings at the center of the theoretical and political dispute. (shrink)

In late February and early March 2020, Italy became the European epicenter of the COVID-19 pandemic. Despite increasingly stringent containment measures enforced by the government, the health system faced an enormous pressure, and extraordinary efforts were made in order to increase overall hospital beds’ availability and especially ICU capacity. Nevertheless, the hardest-hit hospitals in Northern Italy experienced a shortage of ICU beds and resources that led to hard allocating choices. At the beginning of March 2020, the Italian Society of Anesthesia, (...) Analgesia, Resuscitation, and Intensive Care issued recommendations aimed at supporting physicians in prioritizing patients when the number of critically ill patients overwhelm the capacity of ICUs. One motivating concern for the SIAARTI guidance was that, if no balanced and consistent allocation procedures were applied to prioritize patients, there would be a concrete risk for unfair choices, and that the prevalent “first come, first served” principle would lead to many avoidable deaths. Among the drivers of decision for admission to ICUs, age, comorbidities, and preexisting functional status were included. The recommendations were criticized as ageist and potentially discriminatory against elderly patients. Looking forward to the next steps, the Italian experience can be relevant to other parts of the world that are yet to see a significant surge of COVID-19: the need for transparent triage criteria and commonly shared values give the Italian recommendations even greater legitimacy. (shrink)

Many published instruments for assessing adolescent adjustment can be implemented in the school context. However, most of them fail to include a comprehensive and positive theoretical perspective of adolescent development and, even when they do, priority is often given to the clinical perspective, or problems with ecological validity and cost-effectiveness emerge. The Magallanes Adaptation Scale is a 90-item Likert-instrument designed for Spanish-speaking adolescents in order to screen several adjustment areas from a holistic and positive perspective of development. Although some evidence (...) of its psychometric robustness has been tested, no confirmatory analysis of its structure has been published. This paper analyzes the items and the factor structure (exploratory factor analysis and confirmatory factor analysis, using the split-half method) of the scales. Participants were 948 Spanish adolescents (49.84% girls) aged between 11 and 17 and stratified sampled. Thirty-six items were removed from the item analysis. The results of the exploratory factor analysis revealed five factors, excluding mother’s adaptation. Several models were tested during the confirmatory factor analyses, with a 24-item second-order four-factor solution being found to have the best adjustment indicators. The short version proposed in this paper can constitute a helpful tool with screening purposes to help school teachers to assess students’ overall development beyond mere academic performance, although further validity research is needed. (shrink)

Some recent uses of artificial intelligence for facial recognition, evaluating resumes, and sorting photographs by subject matter have revealed troubling disparities in performance or impact based on the demographic traits of subject populations. These disparities raise pressing questions about how using artificial intelligence can work to promote justice or entrench injustice. Political theorists and philosophers have developed nuanced vocabularies and theoretical frameworks for understanding and adjudicating disputes about what justice requires and what constitutes injustice. The interdisciplinary community committed to understanding (...) and conscientiously using big data could benefit from this work. Thus, in the spirit of encouraging cross-disciplinary dialogue and collaboration, this piece examines contemporary scholarship in political theory and philosophy to illustrate some of the vocabularies and frameworks political theorists and philosophers have developed for thinking about justice and injustice. It then draws on these frameworks to illuminate how the use of artificial intelligence can implicate questions of justice, with a focus on institutional discrimination, structural injustice, and epistemic injustice. Ultimately, the piece argues that the use of artificial intelligence—far from representing a decision to take power out of human hands—represents a novel way of harnessing human power, making questions of justice central to its conscientious undertaking. (shrink)

El objetivo de este texto es investigar sobre los posibles puntos de encuentro entre la psicoterapia existencial, un paradigma psicológico arraigado en las filosofías de la existencia, y el posicionamiento del profesor Marino Pérez Álvarez, quien se define a sí mismo como conductista radical, respecto a su manera de entender la existencia humana y el modelo más adecuado de psicoterapia. Para ello se proponen seis puntos de encuentro: necesidad de una fundamentación filosófica para la psicología, crítica al cientificismo y al (...) modelo médico, interpretación de los trastornos mentales como problemas de la vida cotidiana, recuperación del paciente como protagonista de la terapia, crítica a la psicología positiva y crítica al dualismo cartesiano. (shrink)

Although the literature on corporate social responsibility has discussed the scope and meaning of CSR extensively, confusion still exists regarding how to define the concept. One controversial issue deals with the changing legal status of CSR. Based on a review of CSR definitions and meta-studies on CSR definitions, we find that the majority of definitions leans toward voluntary CSR. However, some recent regulatory amendments toward mandatory CSR have called into question the established idea of CSR as merely a managerial tool (...) of self-regulation. In this paper, we juxtapose the evolution of CSR in India against the scholarly literature discussing voluntary-versus-mandatory CSR to understand the recent shift toward a new conceptualization of CSR as a form of co-regulation that includes elements of both voluntary and mandatory regulation. The Indian Companies Act 2013 is a remarkable example in that it replaced an older version from 1956, taking a bold step toward the integration of voluntary and mandatory aspects in the application of CSR. We present practical implications of the Indian case for businesses and discuss implications for CSR theory development; we particularly consider the evolution of the business and society relationship from a voluntary soft law approach to CSR to an increasingly hard law approach and transitory hybrid forms in-between like soft–hard law and hard–soft law. (shrink)

After the establishment of the independent Slovak Republic, legal and institutional ground rules were set for providing asylum to foreigners present on the territory of the Slovak Republic. The national legislation of the last twenty years was adopted in compliance with international treaties and the European Union instruments covering asylum matters. In the field of asylum policy, the Slovak Republic complies with its traditional pillars and supports new forms of protection following the new challenges faced by the international community. The (...) currently valid Asylum Act regulates the international protection of aliens in the Slovak Republic, by defining the conditions and procedures related to granting asylum and provision of subsidiary protection and temporary shelter. The Asylum Act also covers the rights and obligations of different categories of persons, stay in asylum facilities and, partially, the integration of persons that are granted asylum. This article describes and analyses the development of the Slovak asylum legal framework and the concept of asylum policy. Furthermore, it looks at different protection statuses granted to foreigners and finally deals with the refugee migration trends in the Slovak Republic. (shrink)

The U.S. relations to Democratic People’s Republic of Korea are since the end of the Cold War revolving around achieving a state of nuclear free Korean peninsula. As non-proliferation is a long term of American foreign policy, relations to North Korea could be categorized primarily under this umbrella. However, the issue of North Korean political system also plays role as it belongs to the other important, more normative category of U.S. foreign policy which is the protection of human rights and (...) spreading of democracy and liberal values. In addition, the North Korean issue influences U.S. relations and interests in broader region of Northeast Asia, its bilateral alliances with South Korea and Japan as well as sensitive and complex relations to People’s Republic of China. As the current administration of president Donald J. Trump published its National security strategy and was fully occupied with the situation on Korean peninsula in its first year, the aim of the paper is to analyse the changes in evolution of U.S. North Korean policy under last three administrations, look at the different strategies adopted in order to achieve the same aim, the denuclearization. The paper does not provide a thorough analysis, neither looks at all documents adopted and presented in the U.S. or within the U.N. It more focuses on the general principles of particular strategies, most significant events in mutual relations as recorded by involved governmental officials and also weaknesses of these strategies as none has achieved desirable result. In conclusion, several options for current administration are drawn, however all of them require significant compromises and could be accompanied with series of setbacks dangerous for regional stability and U.S. position in the region. (shrink)

Given a space in an elementary submodel M of H, define XM to be X∩M with the topology generated by . It is established, using anti-large-cardinals assumptions, that if XM is compact and its regular open algebra is isomorphic to that of a continuous image of some power of the two-point discrete space, then X=XM. Assuming in addition, the result holds for any compact XM satisfying the countable chain condition.

The aim of our study was to investigate the effects of a small therapeutic animal on the social behavior of nine autistic children. The social contacts of the autistic children were evaluated by a descriptive method of direct observation that was performed without and with the presence of a TA. In period one, contacts with an unfamiliar person and acquaintances were registered; in period two, contacts with the acquaintances and the TA were registered. The frequency of contacts of autistic children (...) with their acquaintances significantly increased in the presence of the TA . The frequency of contacts with the TA was significantly higher than the frequency of contacts with the UP . The form of the autistic children’s contacts with A, with the UP, and with the TA was individually dependent, and the presence of the TA changed the characteristics of contacts with A. Our results indicate that the presence of a small TA can positively influence the quantity and quality of the social behavior of autistic children and that the characteristics of social contacts were dependent on the individual. (shrink)

The aim of the study was to explore the experiences of night nurses. An interpretative phenomenological study was undertaken, and 35 nurses working in Italian medical, surgical and intensive care units were purposely recruited. Data were gathered in 2010 by semi‐structured interviews, collecting nurses' narratives, memorable cases and metaphors, aimed at summarising the essence of work as a nurse during the night. The experience of night nursing is based on four interconnected themes: (i) working in a state of alert, (ii) (...) growing by expanding autonomy and responsibility, (iii) assuring sensitive surveillance and (iv) experiencing deep intimacy. Memorable episodes were polarised along (i) expected/unexpected events; (ii) positive/negative epilogues; and (iii) life/death issues. Many of the emergent metaphors described working during the night as being in the middle of a space where an apparent calm scene takes place, but unpredictable factors may suddenly change the order of events and the outcomes, creating chaos. Working during the night alerts nurses, who increase autonomy, expanding their role and assuming more responsibility with respect to that assumed during daily shifts. The nurses' clinical reasoning is based on data they carefully listen to, and on the meaning that nurses give time by time to different noises and silence. While in the past a sense of companionships was reported, a loneliness or a ‘neutral’ experience concerning the relationships with colleagues seems to prevail during night nursing. Working night shifts is a complex task, and specific training must be assured to students/novices. (shrink)

The rise of the idea of the Anthropocene is promoting multiple reflections on its meaning. As we consider entering this new geological epoch, we realize the pervasiveness of humankind’s deconstruction and reconstruction of the Earth, in both geophysical and discursive terms. As the body of the Earth is marked and reshaped, so is its idea. From a hostile territory to be subjugated and exploited through sovereign commands, the Earth is now reframed as a vulnerable domain in need of protection. The (...) mode of sovereignty, which has accompanied human and legal history and practice during modernity and its project of mastery, is no longer useful. Humanity’s control of the Earth is being reimagined and reconfigured along biopolitical coordinates of thought and action. Biopolitics shifts the focus of power, changes its modalities of interventions, and rearticulates its legitimacy on the idea of taking responsibility for the Earth, for nature. A biopolitical re-orientation of law captures the fundamental aim of caring for nature, of fostering its vital possibilities and of enhancing its productive potential. Yet, biopolitics engulfs nature in its entirety under its framework of control, where protection and subjugation, vulnerability and productivity, life and death are constantly entangled in a reciprocal and inevitable relation of indistinguishability. Sovereignty becomes thus a key modality of biopolitical intervention, when nature is recalcitrant, wild, spontaneous, unpredictable, violent, dangerous. Biopolitics, thus, remains caught in an undecidable dilemma, where in order to protect the Earth, it must subjugate it; to save it, it must condemn it. In this respect, biopolitics remains utterly modern, or as argued by Roberto Esposito, modernity has always been biopolitical, insofar as modernity has emerged as a framework for the protection of life against life’s own excesses. But how can we escape the biopolitical reframing and enframing of the Earth and its total subsumption under its matrix of control? How can we rethink the encounter between law and nature without remaining entangled in the aporetic dilemma of biopolitics? An aesthetics of wonder may offer a way. (shrink)

Drawing on many areas of expertise, from paleontology to psychology, Tomasello offers a plausible, evolutionary story abouthow our ancestors are likely to have developed cooperative behaviors and collaborative lifeways in order to survive and thrive.He also claims that this narrative explains why they would have begun to think in characteristically cooperative and moral ways,developing a “we is greater than me” [we>me] psychological orientation. Do the arguments offered support this extra claim? Thisarticle suggests that they do not. It seeks to alleviate (...) this shortcoming by drawing upon some conceptual resources offered bySartre’s Theory of Practical Ensembles. The centerpiece of the article consists of a detailed analysis of Sartre’s account of the genesisof the “group-in-fusion,” seeking to show that the genesis of a we-way of thinking in a group made up of many requires themediation of what Sartre calls a “third party” (le tiers). After closely examining Sartre’s treatment of the “third party” in theapocalyptic genesis of the “group-in-fusion,” I evaluate the success of this notion in resolving those questions that Tomasello’saccount raises while, at the same time, addressing the ontological question concerning the nature of the individual-grouprelation, in a way that suggests new and significant alternatives to standard dilemmas in contemporary social philosophy. (shrink)

Political theorists have written a great deal about the ethics of “intervention,” defined as states using coercion or force to interfere in foreign societies’ politics. But this work leaves much of global politics un-analyzed—both because non-state actors play an increasingly significant role in it and because its practitioners use many tactics besides force and coercion.We need an ethics of foreign influence to help us navigate the global political arena in all its complexity. Here, I begin to develop a unified theory (...) of the ethics of deliberate attempts to promote justice in foreign societies, whether undertaken by state or non-state actors, and whatever tactics they employ. I identify two important but under-appreciated dimensions along which instances of foreign influence can differ and argue that, once we appreciate the full range of forms foreign influence can take, we’ll see it’s often immune to the common moral objections against intervention. (shrink)

As one tries to grasp love and its images within José Leonilson's production, a multiplicity of aspects and meanings are seen that also relate to Louise Bourgeois's oeuvre in regard to the interest in human relations. Through a comparative approach to both artists' poetics, an understanding is created that love is not a simplistic action and all the words read in or applied to their visual discourse must be considered within a wide range of love in visual and literary images. (...) Keywords: literature and visual arts / love / creativity / Bourgeois, Louise / Leonilson, José / word and image. (shrink)

Campbell, Ulrich, and Grady (2016) should be commended for attempting to contribute to the discussion of what many believe is currently a messy concept. They propose that a broader definition of mo...

This study investigated students’ perceptions following a prepared, common presentation regarding academic integrity provided by their residence dons. This peer instruction study utilized both quantitative and qualitative analyses of survey data within a pre-test post-test design. Overall, students reported gains in knowledge, as well as confidence in their knowledge of academic integrity. Notably, students reported increases in their personal value for academic integrity after participating in the presentations. Overall, the quality and content of the presentations were judged positively, and participants’ (...) ratings of the presentation were predictive of increases in personal value of academic integrity, as well as self-reported knowledge and confidence gains. Qualitative analyses supported that the key ideas in the presentation served as the focal material for discussion, but also introduced specific topics that students wanted to explore in greater depth. (shrink)

The intentionality of improvisation represents surely one of the most pressing and controversial issues in contemporary action theory: how do we find the way to characterize the proper intentionality of improvisation, which is an unplanned yet intentional action? This article will address this question bringing together Merleau-Ponty’s motor intentionality and Bergson’s conception of duration. My argument will unfold in three main stages. First, I will briefly describe the traditional scheme that is used to think of intentional action in contemporary action (...) theory and discuss how the phenomenon of improvisation casts doubts on it. Second, I will outline an initial, and provisional account of improvisation by crossing the descriptions of musical improvisation provided by Jankélévitch with the testimonials of two improvisatory composers—Enrico Pieranunzi and Keith Jarrett—and reports from Charles Rosen, an American pianist and Roger Sessions, an American composer. Finally, I will refine the basic concepts and lay out a phenomenological account of improvisation, by extending and applying the phenomenological notion of motor intentionality to the examples and testimonials gathered from the observation of a specific kind of improvisatory activity—musical composition. This methodology is intended to contrast both with more standard philosophical approaches based on hypothetical examples, and with more standard laboratory-based methodologies in cognitive sciences, psychology, and experimental philosophy. Overall, this approach is intended to redress the balance of action theory—one-sided directed towards planning, as a key aspect of human agency—with an analysis of the bodily and responsive aspect of intentionality. (shrink)

If a state commits injustice, who is responsible for compensating its victims and safeguarding against future wrongdoing? Do the state’s citizens bear this responsibility? Do they all bear it equally? Avia Pasternak's and Holly Lawford-Smith's recent books address these pressing questions. Each book represents a thought-provoking attempt to derive an account of citizen responsibility for state wrongs from an account of state agency understood as group agency. Though the books demonstrate the promise of this approach to produce action-guiding advice for (...) real policymakers, they also demonstrate its limitations—in particular, its lack of attention to social structures. Here, I argue that Pasternak's and Lawford-Smith's views would be enriched by further engagement with the literature on structural injustice, which takes individuals’ perpetuation of social systems (not their implication in acts of group agency) as a central source of their remedial obligations. Through critical engagement with Pasternak and Lawford-Smith, I illustrate how a structural injustice framework could yield more attractive conclusions than a group agency framework in certain cases, better explain non-culpable forms of citizen responsibility, and allow us to theorize citizen responsibility for state action without making questionable claims about the metaphysics or social ontology of group agency. (shrink)

The general question to be considered in this paper points to the nature of the world described by chemistry: what is macro-chemical ontology like? In particular, we want to identify the ontological categories that underlie chemical discourse and chemical practice. This is not an easy task, because modern Western metaphysics was strongly modeled by theoretical physics. For this reason, we attempt to answer our question by contrasting macro-chemical ontology with the mainstream ontology of physics and of traditional metaphysics. In particular, (...) we introduce the distinction between stuff-ontology, proper of chemistry, and individual-ontology, proper of physics. These two ontologies differ from each other in the basic categories of their own structures. On this basis, we characterize individual-ontology in such a way that the features of stuff-ontology will arise by contrast with it. (shrink)

This paper aims to explore the cartographical method as a political option able to destroy the linguistic and semiotic empire of sense. Starting from the difference between map and tracing, Deleuze and Guattari understood the power of a rhizomatic expression, commonly represented by the obsessive and compulsive gesture of autistics, or their impossibility of speaking correctly. This phenomenon has been deeply analysed by Fernand Deligny through his experience in the Cévennes, where he inaugurated his personal anti-psychoanalytic and anti-linguistic method. During (...) this collective living, the wanderings of the autistic children, called Lignes d’erre, were traced and gathered in a cartography in which action overtakes word and speech, and human gestures are reterritorialized. Characterized by movement without finality, life in Cévennes becomes a “life raft”, where the raft is no more the shipwreck of humanity, but the shelter for no- speakers. Therefore, a new spatial configuration is given, where the bonds between people and with objects exist exactly as the pieces of wood in the raft: namely slacken, rhizomatic. (shrink)

Cet ouvrage vise à montrer que la question de la réflexion et de son éveil au sein de la vision occupe une place centrale dans la pensée de Maurice Merleau-Ponty et apparaît comme la source secrète d'une énigme et d'une interrogation fondamentales, à partir desquelles son oeuvre entière peut être relue et révéler une nouvelle cohérence. Mais qu'il s'agisse de la perception, de l'expression ou de la chair, c'est à chaque fois la question de la conscience et de son éveil (...) réflexif qui est repensée à nouveau frais et relancée comme un nouveau défi. De ce fait, cet ouvrage vise également à faire apparaître la nouvelle signification - ou configuration - que prend le commencement de la réflexion chez Merleau-Ponty, dans le dévoilement progressif d'une seule figure typique, composée par touches successives, à partir des différentes figurations qu'elle revêt dans son oeuvre. Elle trouve à s'incarner dans la figure, hautement évocatrice du peintre qui "pense le pinceau à la main", au moment "où sa vision se fait geste". [Source: 4e de couv.]. (shrink)

La investigación propuesta indagó las relaciones que existen entre el derecho a la memoria y el derecho a la ciudad. Para ello se analizaron desde una teoría crítica de los derechos humanos y teniendo como punto de contacto entre ambos derechos las inscripciones espaciales que materializan la memoria colectiva en la ciudad de Madrid. Es así que se buscó comprobar, desde una dimensión jurídica basada en un enfoque de derechos y con perspectiva espacial, si aquellos lugares que materializan y garantizan (...) la memoria pueden a su vez garantizar el acceso al derecho a la ciudad en virtud de que colaboran en la creación de una ciudad más democrática. La metodología empleada consistió en un análisis crítico de textos, relevamiento y estudio exhaustivo de las normas y estándares nacionales e internacionales, políticas públicas locales, observación y registro de los lugares y, por último, una entrevista en profundidad mediante la técnica de muestra de caso sumamente importante para el problema analizado. (shrink)

The target article by Grady and colleagues (2008) is a valuable and exciting contribution to the debate about the importance of ethics education for nurses. The findings indicated that ethics educa...