In lieu of an abstract, here is a brief excerpt of the content:Training and Other Important Needs for Nursing AssistantsNanci RobinsonTraining of Nursing AssistantsI think the nursing assistant (NA) training programs should be longer. My original course for Long Term Care was four weeks long after that I took an additional two months at a hospital to work on a Med/ Surg floor. So, I have a combined three months of schooling.Personally, I'd like to see certified nursing assistants (CNAs) given (...) more responsibilities. I'd like to see a six-month program to include CPR and capillary blood glucose (CBG) training as well as more in depth anatomy training. I think six months would keep some, who are just looking for money, out of the field and help keep those of us who really want a career in nursing in the field. It would be a better stepping stone for those who plan to go on to a LPN or RN program.I currently have CBG training but my employer will not let me use it. It's disappointing because it's a skill I have that I can't use and it could really help out the nurses. I think if courses were a bit longer, CNAs might be taken a bit more seriously by their employers and respected by their colleagues in the medical field.I was trained in CBG while working for the hospital and received a card like a CPR card to show I was trained. I live and work and was trained in Arkansas. I'm not allowed to do CBGs in the long-term care and rehab facility where I work now, though. However, unless the resident is diabetic we do have to clip and file nails. It took many years for nurses to gain respect and be allowed to do some things that now CNAs do. For example, for many years doctors didn't feel nurses were qualified to even take vital signs. I suppose CNAs will have the same struggle. [End Page 147]"I'm wondering if extending the initial training time would not keep many out of the field, because they need a job with income ASAP." The same could be said for LPN training, could it not? Or even an RN. I don't understand why there is a train of thought that "anyone" should be allowed to be a CNA and as quickly as possible. I can tell when I'm working alongside a Certified Nursing Assistant who is in it because they want to be versus someone who wants the paycheck (not sure why, though, because to be honest Arkansas doesn't pay CNAs all that great, though I suppose for some it might be better than McDonalds). I took a $5 an hour paycut go get back into nursing because it's my passion, and while we all need a paycheck, that should not be the only reason for doing this work."If extending the initial training time would keep many out of the field because they need a job with income ASAP, maybe employer facility-specific follow-up training would seem to be much more feasible for all. A CNA-in-training could be responsible for a lighter than 'normal' shift assignment while under the guidance of a qualified proctor CNA. It could improve efficiency and quality of care in the long run and probably improve retention rate of CNAs, for those administrators that are astute enough to consider the long-term effects of their policies." This might be good—the only problem is that most facilities aren't going to want to absorb any cost this might create by having additional staff for this purpose. Also, on the job training is not appreciated by employers as much as what might be considered actual "education" hours. Most CNAs want to do as much patient care as they can for the nurse—learning to assist with dressing changes, CBGs and other things that would be beneficial for both CNAs and the Nurse.Ensuring there is enough staff and that those staff members are there for the right reasons would do much more to improve the retention rate of NAs or CNAs. (I'm a... (shrink)

This book explores policy innovation for same-sex couples throughout the Americas and includes same-sex marriage legislation, civil unions, and other new developments for same-sex couples throughout the Americas at both national and sub-national levels. This scholarship is innovative because though much has been written regarding developments in North America, there is very little work dealing with recent developments in the rest of the Americas.

Providing the most thorough coverage available in one volume, this comprehensive, broadly based collection offers a wide variety of selections in four major genres, and also includes a section on film. Each of the five sections contains a detailed critical introduction to each form, brief biographies of the authors, and a clear, concise editorial apparatus. Updated and revised throughout, the new Fourth Edition adds essays by Margaret Mead, Russell Baker, Joan Didion, Annie Dillard, and Alice Walker; fiction by Nathaniel Hawthorne, (...) Ursula K. LeGuin, Anton Chekov, James Joyce, Katherine Mansfield, F. Scott Fitzgerald, William Faulkner, Alice Walker, Louise Erdrich, Donald Barthelme, and James McPherson; poems by John Donne, Robert Browning, Walt Whitman, Edwin Arlington Robinson, e.e. cummings, Langston Hughes, W.H. Auden, Philip Levine, and Louise Gluck; and plays by August Wilson, Marsha Norman, Wendy Wasserstein, and Vaclav Havel. The chapter devoted to film examines the relation of film to literature and gives the complete screenplay for Citizen Kane plus close analysis of a scene from the film. With its innovative structure, comprehensive coverage, and insightful and stimulating presentation of all kinds of literature, this is an anthology readers will turn to again and again. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Pride in Giving Care and Other Life Lessons from Certified Nursing AssistantsDelese WearMy father spent the last three weeks of his life in a hospice care facility. It's funny, now reading these narratives written by Certified Nursing Assistants (CNAs), that I can't picture him without Gloria, the CNA who worked the 7-3 shift, floating quietly in and out of his room, tending to him, tending to us, speaking quietly (...) to Dad even when he was no longer conscious, offering us conversation, often her affectionate observations of Dad and curiosity about his life, sometimes about life on the "outside," a kind of respite from total attention on Dad and our grieving. I remember the smell of the lotion she rubbed on his body. I remember no other caregivers in his room; there obviously were, but I can't picture them now, only Gloria. We never spoke directly to the medical director of the hospice. He was a phantom, rounding at 5 or 6 a.m.; we came to believe he did so to avoid speaking to families.Those three weeks led to my conceptions about CNAs—the nature of the work they do, the kinds of people who do such work, the awesome responsibilities involved in such work, and not least, the physical and emotional resiliency of those who undertake such work. My and my family's often recited, "How does she do this every day?" was answered time and again in the narratives written by CNAs in this issue of the journal.But before moving forward, I want to make note of how I will refer to the authors of these narratives. The name of one's occupation, the title one uses, and how others refer to your occupation, is obviously meaningful. If the snapshots of CNAs provided in these narratives are somewhat representative, we find those who refer to themselves and their occupation as nursing assistants, nurse assistants, Certified Nursing Assistants (CNAs), State Licensed Nursing Assistants (SLNA), or simply aides, to name a few. While it is beyond the space offered here, I want to make note of this, recognizing that titles/labels matter, and to acknowledge that status. As CNA Nanci Robinson notes, "most of us are certified... I wouldn't call an LPN a PN and leave out she's licensed." Passage of the Omnibus Budget Reconciliation Act of 1987 (OBRA 87), required each State to establish State-approved nurse aide training programs and establish requirements for nurse aide competency. Thus, I will refer to all the authors here as Certified Nursing Assistants (CNAs). I do wonder how significant of an issue these variations of titles are within the larger nursing assistant culture, and how it may contribute to disparities regarding pay schedules, duties, status, training and other relevant issues among all nursing assistants.In spite of problems, stressors, and other quality of life issues for CNAs, most of them spoke with pride and meaning regarding what was for many their "life's work," similar to what one might expect to find in other care giving occupations. Some spoke of a "love of the work," its "rewards" and "joys," [End Page 165] and the intense satisfaction of "making a difference" in patients' or residents' lives. These attitudes were not vague abstractions but were grounded throughout the narratives in rich examples of the affirming aspects of their work.It appears that much of the pleasure comes from what many refer to as the "hands on," "direct care," or "front line" nature of the work—often what other health professionals might view as things they would not want to do. And of course these other professionals—registered nurses, occupational therapists, and physicians—could make the same claim when describing the "hands-on" joys of their work. But the differences, it would seem, are profound between these other caregivers and CNAs. The CNA narratives report fundamentally intimate and often daily relationships with their clients/residents/patients. Danny Reed describes the "delight" he feels "in restoring dignity to every human in need of it regardless of cause," referring to himself as a "participant observer in a caring relationship," not as a "detached clinician." Many spoke directly... (shrink)

U Rusiji, dve decenije nakon urusavanja Sovjetskog Saveza, Staljinova popularnost je po anketama javnog mnjenja ogromna, posto se mnogi prisecaju nekadasnjeg ugleda zemlje i svog osecaja sigurnosti. Slicno tome, mnogi Srbi, koji su bili najveca grupa u bivsoj Jugoslaviji, s nostalgijom su gledali na vreme nacionalnog ponosa i materijalnog komfora. Nasuprot tome, potcinjene etnicke zajednice u isto to vreme osecale su frustraciju u teznji za nacionalnim ponosom. Svaki politicki poredak ima jednu pripovest sacinjenu od odabranih i povezanih dogadjaja koji promovisu (...) nacionalne interese. Iako se zavrsila oruzana borba, u bivsoj Jugoslaviji ostala je podeljenost koja je perpetuirana konkurentskim narativima o tome sta se i zbog cega dogodilo. U Rusiji,?nevidiljivi staljinizam? u porastu jos jednom je omalovazio iskustvo zrtava represije. Ovaj clanak pruza preliminarna razmatranja o razdvajanju narativa u Rusiji i Srbiji i pokusava da objasni jednu od kljucnih prepreki u pomirenju s prosloscu. (shrink)

This entry concerns dualism in the philosophy of mind. The term ‘dualism’ has a variety of uses in the history of thought. In general, the idea is that, for some particular domain, there are two fundamental kinds or categories of things or principles. In theology, for example a ‘dualist’ is someone who believes that Good and Evil — or God and the Devil — are independent and more or less equal forces in the world. Dualism contrasts with monism, which is (...) the theory that there is only one fundamental kind, category of thing or principle; and, rather less commonly, with pluralism, which is the view that there are many kinds or categories. In the philosophy of mind, dualism is the theory that the mental and the physical — or mind and body or mind and brain — are, in some sense, radically different kinds of thing. Because common sense tells us that there are physical bodies, and because there is intellectual pressure towards producing a unified view of the world, one could say that materialist monism is the ‘default option’. Discussion about dualism, therefore, tends to start from the assumption of the reality of the physical world, and then to consider arguments for why the mind cannot be treated as simply part of that world. (shrink)

This paper examines a doctrine which David Lewis has called 'Humean Supervenience' (hereafter 'HS'), and a problem which certain imaginary cases seem to generate for HS. They include rotating perfect spheres or discs, and flowing rivers, imagined as composed of matter which is perfectly homogeneous right down to the individual points. Before considering these examples, I shall introduce the doctrine they seem to challenge.

Some health care organizations allow physicians to withhold cardiopulmonary resuscitation from a patient, despite patient or surrogate requests that it be provided, when they believe it will be more harmful than beneficial. Such cases usually involve patients with terminal diagnoses whose medical teams argue that aggressive treatments are medically inappropriate or likely to be harmful. Although there is state-to-state variability and a considerable judicial gray area about the conditions and mechanisms for refusals to perform CPR, medical teams typically follow a (...) set of clearly defined procedures for these decisions. The procedures are based on the principle of nonmaleficence and typically include consultation with hospital ethics committees, reflecting the guidelines of relevant professional associations. Ethical debates about when CPR can and should be limited tend to rely more on discussions of theory, principles, and case studies than systematic empirical study of the situations in which such limitations are applied. Sociologists of bioethics call for empirical study, arguing that what ethicists and health professionals believe they are doing when they draft policies or invoke principles does not always mirror what is happening on the ground. In this article, we begin the task of modeling the empirical analyses sociologists call for, focusing on a cohort at Massachusetts General Hospital. We inductively analyzed ethics committee notes and medical records of nineteen patients whose surrogates did not accept the decision to withhold CPR. (shrink)

The purpose of this book is to clarify the concept of definition and improve defining activities.

In this paper, we are concerned with the arithmetical definability of certain notions of integers and rationals in terms of other notions. The results derived will be applied to obtain a negative solution of corresponding decision problems.In Section 1, we show that addition of positive integers can be defined arithmetically in terms of multiplication and the unary operation of successorS(whereSa=a+ 1). Also, it is shown that both addition and multiplication can be defined arithmetically in terms of successor and the relation (...) of divisibility | (wherex|ymeansxdividesy). (shrink)

Epiphenomenalism is the view that mental events are caused by physical events in the brain, but have no effects upon any physical events. Behavior is caused by muscles that contract upon receiving neural impulses, and neural impulses are generated by input from other neurons or from sense organs. On the epiphenomenalist view, mental events play no causal role in this process. Huxley (1874), who held the view, compared mental events to a steam whistle that contributes nothing to the work of (...) a locomotive. James (1879), who rejected the view, characterized epiphenomenalists' mental events as not affecting the brain activity that produces them "any more than a shadow reacts upon the steps of the traveller whom it accompanies". (shrink)

In the last decade, experimental philosophers have documented systematic asymmetries in the attributions of mental attitudes to agents who produce different types of side effects. We argue that this effect is driven not simply by the violation of a norm, but by salient-norm violation. As evidence for this hypothesis, we present two new studies in which two conflicting norms are present, and one or both of them is raised to salience. Expanding one’s view to these additional cases presents, we argue, (...) a fuller conception of the side-effect effect, which can be reversed by reversing which norm is salient. (shrink)

Los nuevos roles de participación ciudadana, vienen de parte de otros sujetos y actores sociales que en nada se vinculan u originan con los protagonismos institucionales que caracterizaron hasta hacemuy poco la actividad política en los países latinoamericanos. Estos han sido desplazados por completo, en lamedida que su fracaso reveló el fracaso de la democracia representativa para legitimar los poderes gubernamentales, cuando en su efecto no logró los cambios que se prometían a través de las vías de la constitucionalidad y (...) el discurso ideológico. Las nuevas prácticas políticas que se insertan en el campo de la participación política son ahora mucho más directas con respecto a los sectores marginados, y la forma en la que éstos se han hecho presentes a través de las protestas y cualquier tipo de desobediencia civil en el espacio público, logrando enfrentar al Estado con los reclamos de quienes siendo la mayoría no han dejado de sufrir la explotación y alineación económica y política. (shrink)

It is traditionally believed that cerebral activation (the presence of low voltage fast electrical activity in the neocortex and rhythmical slow activity in the hippocampus) is correlated with arousal, while deactivation (the presence of large amplitude irregular slow waves or spindles in both the neocortex and the hippocampus) is correlated with sleep or coma. However, since there are many exceptions, these generalizations have only limited validity. Activated patterns occur in normal sleep (active or paradoxical sleep) and during states of anesthesia (...) and coma. Deactivated patterns occur, at times, during normal waking, or during behavior in awake animals treated with atropinic drugs. Also, the fact that patterns characteristic of sleep, arousal, and waking behavior continue in decorticate animals indicates that reticulo-cortical mechanisms are not essential for these aspects of behavior. (shrink)

Moral principles play important roles in diverse areas of moral thought, practice, and theory. Many who think of themselves as ‘moral generalists’ believe that moral principles can play these roles—that they are capable of doing so. Moral generalism maintains that moral principles can and do play these roles because true moral principles are statements of general moral fact (i.e. statements of facts about the moral attributes of kinds of actions, kinds of states of affairs, etc.) and because general moral facts (...) explain particular moral facts (i.e. facts about the moral attributes of particulars). Moral holism maintains that what is a moral reason to φ in one case may not be one in another, and may even be a moral reason not to φ given suitable circumstances. Some ‘moral particularists’ maintain that moral holism motivates scepticism about the existence of and need for moral principles, along with scepticism about the viability of principle-based approaches to ethics and moral theory. But I argue that moral holism is itself a form of moral generalism, one that takes facts about the right- and wrong-making powers of (generic) moral factors to explain certain particular moral facts—namely, the rightness and wrongness of particular actions. I also argue that a moral-theoretic version of dispositionalism—the view that dispositions, powers, or capacities are the fundamental units of explanation—explains both why moral holism is true and why moral generalism is true. (shrink)

Recent findings in experimental philosophy have revealed that people attribute intentionality, belief, desire, knowledge, and blame asymmetrically to side- effects depending on whether the agent who produces the side-effect violates or adheres to a norm. Although the original (and still common) test for this effect involved a chairman helping or harming the environment, hardly any of these findings have been applied to business ethics. We review what little exploration of the implications for business ethics has been done. Then, we present (...) new experimental results that expand the attribution asymmetry to virtue and vice. We also examine whether it matters to people that an effect was produced as a primary or side- effect, as well as how consumer habits might be affected by this phenomenon. These results lead to the conclusion that it appears to be in a businessperson’s self-interest to be virtuous. (shrink)

This article develops an approach to ethical globalization based on a feminist, political ethic of care; this is achieved, in part, through a comparison with, and critique of, Thomas Pogge's World Poverty and Human Rights. In his book, Pogge makes the valid and important argument that the global economic order is currently organized such that developed countries have a huge advantage in terms of power and expertise, and that decisions are reached purely and exclusively through self-interest. Pogge uses an institutional (...) rights framework to argue that direct responsibility for global poverty and inequality lies with the citizens of developed countries, since suffering and death are caused by global economic arrangements designed and imposed by our governments. While this argument is certainly compelling, I have argued that it tells us little about the actual effects of globalization on the real people of the South - including women, children and the elderly. As a result, it can offer little in the way of real alternatives or policy prescriptions. As a moral orientation, a care ethic relies on a relational moral ontology, and leads us to consider different values in terms of human flourishing. Moreover, it pushes us to consider the normative implications of aspects of the global political economy which are usually not 'seen' at all, including the global distribution of care work and the corresponding patterns of gender and racial inequality, the underprovision of care and resources for caring work in both the developed and developing world, and the ways in which unpaid or low-paid caring work helps to sustain a cycle of exploitation and inequality on a global scale. (shrink)

Empirical research in bioethics has developed rapidly over the past decade, but has largely eschewed the use of technology-driven methodologies. We propose “design bioethics” as an area of conjoined theoretical and methodological innovation in the field, working across bioethics, health sciences and human-centred technological design. We demonstrate the potential of digital tools, particularly purpose-built digital games, to align with theoretical frameworks in bioethics for empirical research, integrating context, narrative and embodiment in moral decision-making. Purpose-built digital tools can engender situated engagement (...) with bioethical questions; can achieve such engagement at scale; and can access groups traditionally under-represented in bioethics research and theory. If developed and used with appropriate rigor, tools motivated by “design bioethics” could offer unique insights into new and familiar normative and empirical issues in the field. (shrink)

This paper begins with a summary of an argument for epiphenomenalism and a review of the author's previous work on the self-stultification objection to that view. The heart of the paper considers an objection to this previous work and provides a new response to it. Questions for this new response are considered and a view is developed in which knowledge of our own mentality is seen to differ from our knowledge of external things.

One antidote to moral distress is stronger moral agency—that is, an enhanced ability to act to bring about change. The Clinical Ethics Residency for Nurses, an educational program developed and run in two large northeastern academic medical centers with funding from the Health Resources and Services Administration, intended to strengthen nurses’ moral agency. Drawing on Improving Competencies in Clinical Ethics Consultation: An Education Guide, by the American Society for Bioethics and Humanities, and on the goals of the nursing profession, CERN (...) sought to change attitudes, increase knowledge, and develop skills to act on one's knowledge. One of the key insights the faculty members brought to the design of this program is that knowledge of clinical ethics is not enough to develop moral agency. In addition to lecture‐style classes, CERN employed a variety of methods based in adult learning theory, such as active application of ethics knowledge to patient scenarios in classroom discussion, simulation, and the clinical practicum. Overwhelmingly, the feedback from the participants (sixty‐seven over three years of the program) indicated that CERN achieved transformative learning. (shrink)

Although it is well documented that language plays an important role in cognitive development, there are different views concerning the mechanisms underlying these effects. Some argue that even early in development, effects of words stem from top‐down knowledge, whereas others argue that these effects stem from auditory input affecting attention allocated to visual input. Previous research (e.g., Robinson & Sloutsky, 2004a) demonstrated that non‐speech sounds attenuate processing of corresponding visual input at 8, 12, and 16 months of age, whereas (...) the current study demonstrates that words attenuate visual processing at 10 months but not at 16 months (Experiment 1). Furthermore, prefamiliarization with non‐speech sounds (Experiment 2) resulted in able processing of visual input by 16‐month‐olds. These findings suggest that some effects of labels found early in development may stem from familiarity with human speech. The possibility of general‐auditory factors underlying the effects of words on cognitive development is discussed. (shrink)

Gossip is rarely praised. There seems little virtuous that is about talking behind someone’s back. Whether there is anything virtuous about gossip, however, depends on the kind of gossip. Some gossip is idle, but some evaluative gossip promulgates and enforces norms. When properly motivated, such gossip effects positive change in society and counts as gossiping well. The virtue of gossiping well even includes some kinds of false gossip, namely the sort that exaggerates a pre-existing trait, thereby creating a caricature of (...) a person’s character in order to establish a moral exemplar (or anti-exemplar). (shrink)

Contemporaries often reject epiphenomenalism out of hand, while Russellian Monism is regarded as worthy of further development. It is argued here that this difference of attitudes is indefensible, because the easy rejection of EPI is due to its violating a certain Causal Intuition, and RM implicitly violates that same intuition. An enriched version of RM mitigates the violation, but the same mitigation results if we make a parallel enrichment of EPI. If RM and EPI are approached on a level playing (...) field, it is not obvious which will prove to be the better view. (shrink)

This article defends epiphenomenalism against criticisms raised in Dwayne Moore’s “On Robinson’s Response to the Self-Stultifying Objection”.

What are moral principles? In particular, what are moral principles of the sort that (if they exist) ground moral obligations or—at the very least—particular moral truths? I argue that we can fruitfully conceive of such principles as real, irreducibly dispositional properties of individual persons (agents and patients) that are responsible for and thereby explain the moral properties of (e.g.) agents and actions. Such moral dispositions (or moral powers) are apt to be the metaphysical grounds of moral obligations and of particular (...) truths about what is morally permissible, impermissible, etc. Moreover, they can do other things that moral principles are supposed to do: explain the phenomena “falling within their scope,” support counterfactuals, and ground moral necessities, “necessary connections” between obligating reasons and obligations. And they are apt to be the truthmakers for moral laws, or “lawlike” moral generalizations. (shrink)

. An attempt is made to identify a concept of ‘downward causation’ that will fit the claims of some recent writers and apply to interesting cases in biology and cognitive theory, but not to trivial cases. After noting some difficulties in achieving this task, it is proposed that in interesting cases commonly used to illustrate ‘downward causation’, (a) regularities hold between multiply realizable properties and (b) the explanation of the parallel regularity at the level of the realizing properties is non-trivial. (...) It is argued that the relation between a realizable property and the property that realizes its effect in a particular case is not usefully regarded as a species of causation and that use of the concept of downward causation deflects our attention from our central explanatory tasks. (shrink)

What are moral principles? The assumption underlying much of the generalism–particularism debate in ethics is that they are (or would be) moral laws: generalizations or some special class thereof, such as explanatory or counterfactual-supporting generalizations. I argue that this law conception of moral principles is mistaken. For moral principles do at least three things that moral laws cannot do, at least not in their own right: explain certain phenomena, provide particular kinds of support for counterfactuals, and ground moral necessities, “necessary (...) connections” between obligating reasons and obligations. Moreover, neither a best-systems theory of moral principles nor any of the competing theories of moral principles proposed by Sean McKeever and Michael Ridge, Pekka Väyrynen, and Mark Lance and Margaret Little could vindicate the law conception of moral principles. I conclude with some brief remarks about what moral principles might be if they are not moral laws. (shrink)

A large number of papers in Computational Cognitive Neuroscience are developing and testing novel analysis methods using one specific neuroimaging dataset and problematic experimental stimuli. Publication bias and confirmatory exploration will result in overfitting to the limited available data. We highlight the problems with this specific dataset and argue for the need to collect more good quality open neuroimaging data using a variety of experimental stimuli, in order to test the generalisability of current published results, and allow for more robust (...) results in future work. (shrink)