The goal of collegial ethics is to actively support our colleagues and to develop the skills needed to do so. While collegial interactions are key for our careers, there is little or no training in this. Many of our actions and reactions with our colleagues are instinctive. Human nature has evolved to be self-protective, but many evolved and automatic responses to others are not always in the best interests of our society or of us. Developing courage and a (...) style of supportive language, avoiding destructive acts, and adhering to the golden rule will improve our relationships and provide a more positive environment for all. (shrink)

The increase of high-risk newborns due to societal changes has presented neonatal intensive care unit nurses with more ethical challenges and heightened their perception of neonatal palliative care. Therefore, this study was a descriptive survey exploring the perceptions of neonatal intensive care unit nurse regarding biomedical ethics and neonatal palliative care in neonatal intensive care units. The research participants were 97 neonatal intensive care unit nurses who had been directly involved with end-of-life care for high-risk babies. Data were collected from (...) November to December 2021 through an online survey. The Korean version of Neonatal Palliative Care Attitude Scale and the tool of biomedical ethics were used. The collected data were analyzed using the T-test, ANOVA, Scheffé test, Pearson correlation coefficient, and multiple regression analysis. The mean score for perception of biomedical ethics in neonatal intensive care unit nurses was 2.89 of 4, and that of neonatal palliative care in neonatal intensive care unit nurses was 3.10 of 5. Existence of a protocol of neonatal palliative care, the experience of patients dying, and the right to life of neonates were factors influencing the perception of neonatal palliative care. The explanatory power was 12.5%. The data support the importance of guidelines regarding systematic neonatal palliative care. Also, developing programs for sharing and supporting experiences of patients dying among colleagues and persistent education about the right to life of neonates for neonatal intensive care unit nurses can improve perception of neonatal palliative care. (shrink)

In their thoughtful and rigorous article, Peterson and colleagues extend an account of supported decision-making that was originally developed for people with static cognitive impairments, t...

Background: International developments suggest that providing clinical ethics services to help clinicians negotiate ethical issues that arise in clinical practice is beneficial and reflects best practice in promoting high ethical standards and patient-centered care. The aim of this study was to explore the needs and experiences of clinical staff members to inform the development of future clinical ethics support. Methods: Health professionals at a large regional health service completed an online survey containing questions about the frequency of ethical and legal (...) issues encountered in clinical practice, the type of situations that gave rise to the ethical and/or legal uncertainty or concern, how clinicians currently address these issues, and what support would be welcome. Results: The survey was completed by 369 staff members, including 61% with more than 10 years in the profession and 51% in nursing/midwifery. Two-thirds (66%) indicated they often considered ethical implications of their clinical decisions, and half (49%) often considered the legal implications. More than half (58%) were often/occasionally concerned about the ethically right thing to do. Patient requests for borderline treatment (47%), staff disagreements about patient care (48%), and patients declining recommended treatment (54%) were the most frequent reasons given for ethical or legal uncertainty. Sixty-nine percent of respondents indicated that the way their department addressed ethical issues could be improved and 85% agreed that there is a need for more discussion on ethical issues. The majority (82%) of respondents had encountered ethically challenging clinical situations where additional support would have helped. Common approaches to issues were discussion with colleagues/supervisor (91.1%), discussion at handover/group forums (50.8%), and consultation with guidelines/protocols (60.9%). Conclusions: A majority of clinical staff members surveyed have encountered ethically/legally challenging cases daily for which they have often sought additional advice. This study indicates that many clinical staff members would welcome some form of additional clinical ethics support including advice and education. (shrink)

The purpose of this study was to investigate external whistleblowers’ experiences of workplace bullying by superiors and colleagues, and to analyze how the bullying was influenced by factors such as the support they received from government or NGOs, and whether colleagues understood the reasons for the whistleblower’s actions. For bullying by colleagues, we also examined to what extent this was influenced by superiors’ behavior towards the whistleblower. We reviewed the relevant literature on workplace bullying and whistleblowers’ experiences (...) of negative or retaliatory actions and developed three hypotheses, which we tested using data gathered from Korean external whistleblowers. Results revealed that external whistleblowers experienced work-related bullying by superiors and social relation-related and person-related bullying by colleagues more frequently, and found it more distressing, than other types of workplace bullying. Superiors’ bullying was a dominant factor affecting bullying by colleagues. Colleagues’ understanding of the reason for the whistleblower’s actions was significant in reducing bullying frequency while support from government and NGOs was not significant in reducing it. Based on these findings, practical implications are discussed. (shrink)

In the last 20 years, amid extensive social and economic reforms, China’s social structure and community life have changed considerably. A large number of social workers are needed to provide many more social services to community residents. The central government has issued many policies to rapidly develop human service organizations and increase the number of social workers. Thus, by the end of 2019, the number of social workers has reached more than 1.5 million in China. At the same time, local (...) governments have issued many policies to promote an increase in the number of social workers. According to statistics from the Chengdu Civil Affairs Bureau, from 2010 to 2021, the number of social workers in Chengdu City increased, remarkably, from 553 to 17,622. Although the number of social workers has increased rapidly, some problems still exist. According to a survey by the Chengdu Social Workers Association, the turnover rate of social workers has reached approximately 20% in Chengdu City in 2018. Therefore, we aim to determine what influences social workers’ job burnout. Through regression analysis and mediation effect tests, we found the following: First, when controlling for gender, age, education, and workday, social support of social workers had a significant negative impact on job burnout. Second, the mindfulness of social workers had a significant negative impact on job burnout. Third, the mindfulness of social workers played a mediating role between social support and job burnout. The mediating effect was −0.116. Fourth, among the three dimensions of social support, mindfulness played a partially mediating role in family support and other support. The mediating effect between other support, which is the support from leaders and colleagues, and job burnout was the strongest, with a mediating effect of −0.109. In other words, the support provided by agency leaders and colleagues can maximize the level of mindfulness of social workers, thereby reducing social workers’ job burnout most effectively. We can thus reduce social workers’ job burnout by improving their level of mindfulness and the social support for them in China. (shrink)

Perceived social support and life-satisfaction The article concerns the relationship between life-satisfaction and the features of interpersonal relationships and social support. The research presented in this paper concerned the satisfaction with the relationships with family members, friends, colleagues and acquaintances, the extent of the relationships among these groups, and the perceived social support. The aim of the presented research is to assess the impact of these characteristics on life-satisfaction. In addition, the changes that occurred after the social skills training (...) in the level of life-satisfaction and its determinants were examined. The study group consisted of 60 participants. The results show that the strongest determinants of life-satisfaction are practical support and the satisfaction with the relationships with friends. After the social training the structure of the determinants changed. The factors which were relevant before the training appear to be insignificant now; however, the emotional support, satisfaction with family relationships and the number of friends gain in importance. The social skills training was also effective and increased the level of life-satisfaction. (shrink)

Evaluating the feasibility and first perceived outcomes of a newly developed clinical ethics support instrument called CURA. This instrument is tailored to the needs of nurses that provide palliative care and is intended to foster both moral competences and moral resilience. This study is a descriptive cross-sectional evaluation study. Respondents consisted of nurses and nurse assistants (n = 97) following a continuing education program (course participants) and colleagues of these course participants (n = 124). Two questionnaires with five-point Likert (...) scales were used. The feasibility questionnaire was given to all respondents, the perceived outcomes questionnaire only to the course participants. Data collection took place over a period of six months. Respondents were predominantly positive on most items of the feasibility questionnaire. The steps of CURA are clearly described (84% of course participants agreed or strongly agreed, 94% of colleagues) and easy to apply (78–87%). The perceived outcomes showed that CURA helped respondents to reflect on moral challenges (71% (strongly) agreed), in perspective taking (67%), with being aware of moral challenges (63%) and in dealing with moral distress (54%). Respondents did experience organizational barriers: only half of the respondents (strongly) agreed that they could easily find time for using CURA. CURA is a feasible instrument for nurses and nurse assistants providing palliative care. However, reported difficulties in organizing and making time for reflections with CURA indicate organizational preconditions ought to be met in order to implement CURA in daily practice. Furthermore, these results indicate that CURA helps to build moral competences and fosters moral resilience. (shrink)

Evaluating the feasibility and first perceived outcomes of a newly developed clinical ethics support instrument called CURA. This instrument is tailored to the needs of nurses that provide palliative care and is intended to foster both moral competences and moral resilience. This study is a descriptive cross-sectional evaluation study. Respondents consisted of nurses and nurse assistants (n = 97) following a continuing education program (course participants) and colleagues of these course participants (n = 124). Two questionnaires with five-point Likert (...) scales were used. The feasibility questionnaire was given to all respondents, the perceived outcomes questionnaire only to the course participants. Data collection took place over a period of six months. Respondents were predominantly positive on most items of the feasibility questionnaire. The steps of CURA are clearly described (84% of course participants agreed or strongly agreed, 94% of colleagues) and easy to apply (78–87%). The perceived outcomes showed that CURA helped respondents to reflect on moral challenges (71% (strongly) agreed), in perspective taking (67%), with being aware of moral challenges (63%) and in dealing with moral distress (54%). Respondents did experience organizational barriers: only half of the respondents (strongly) agreed that they could easily find time for using CURA. CURA is a feasible instrument for nurses and nurse assistants providing palliative care. However, reported difficulties in organizing and making time for reflections with CURA indicate organizational preconditions ought to be met in order to implement CURA in daily practice. Furthermore, these results indicate that CURA helps to build moral competences and fosters moral resilience. (shrink)

In a representative vignette study in Germany with 1,653 respondents, we investigated laypeople’s attribution of moral responsibility in collaborative medical diagnosis. Specifically, we compare people’s judgments in a setting in which physicians are supported by an AI-based recommender system to a setting in which they are supported by a human colleague. It turns out that people tend to attribute moral responsibility to the artificial agent, although this is traditionally considered a category mistake in normative ethics. This tendency is stronger when (...) people believe that AI may become conscious at some point. In consequence, less responsibility is attributed to human agents in settings with hybrid diagnostic teams than in settings with human-only diagnostic teams. Our findings may have implications for behavior exhibited in contexts of collaborative medical decision making with AI-based as opposed to human recommenders because less responsibility is attributed to agents who have the mental capacity to care about outcomes. (shrink)

In this chapter, we explore the question of on what grounds reports of clinical ethics support in general, including especially clinical ethics consultation, can or should be evaluated when using a peer review system. It is our contention that to evaluate clinical ethics consultation within a peer review system aiming at transparency and fairness, a defined and shared criteria of evaluation, i.e. an evaluation standard is required. When evaluating a performed ethics consultation, we can roughly distinguish between an internal standard, (...) which refers to the conceptualization of clinical ethics consultation held by the respective consultant or by the assessed clinical ethics support service themselves, and external standards. Most important is the way how an external standard is being defined: Is it just the standard of another service or colleague? Or is it the result of a larger consensus-building process of a relevant body representing a larger group of colleagues, such as the ASBH? Or does it even rely on the “evidence” of related research? An external standard, however, may rest on criteria that are not – or not fully – accepted by the evaluated CESS or individual ethics consultant. Identifying the internal standard of an observed ethics consultant’s work may also be challenging. From the evaluator’s perspective the responsibility for making an internal standard known and unequivocal lies with the “author” of the material. The potential gap between internal and external standards marks a methodological difficulty that as such has to be addressed within peer review evaluation. (shrink)

Background:The global COVID-19 pandemic has imposed challenges on healthcare systems and professionals worldwide and introduced a ´maelstrom´ of ethical dilemmas. How ethically demanding situations are handled affects employees’ moral stress and job satisfaction.Aim:Describe priority-setting dilemmas, moral distress and support experienced by nurses and physicians across medical specialties in the early phase of the COVID-19 pandemic in Western Norway.Research design:A cross-sectional hospital-based survey was conducted from 23 April to 11 May 2020.Ethical considerations:Ethical approval granted by the Regional Research Ethics Committee in (...) Western Norway (131421).Findings:Among the 1606 respondents, 67% had experienced priority-setting dilemmas the previous two weeks. Healthcare workers who were directly involved in COVID-19 care, were redeployed or worked in psychiatry/addiction medicine experienced it more often. Although 59% of the respondents had seen adverse consequences due to resource scarcity, severe consequences were rare. Moral distress levels were generally low (2.9 on a 0–10 scale), but higher in selected groups (redeployed, managers and working in psychiatry/addiction medicine). Backing from existing collegial and managerial structures and routines, such as discussions with colleagues and receiving updates and information from managers that listened and acted upon feedback, were found more helpful than external support mechanisms. Priority-setting guidelines were also helpful.Discussion:By including all medical specialties, nurses and physicians, and various institutions, the study provides information on how the COVID-19 mitigation also influenced those not directly involved in the COVID-19 treatment of patients. In the next stages of the pandemic response, support for healthcare professionals directly involved in outbreak-affected patients, those redeployed or those most impacted by mitigation strategies must be a priority.Conclusion:Empirical research of healthcare workers experiences under a pandemic are important to identify groups at risks and useful support mechanisms. (shrink)

The paper analyses issues related to supervision and support of early career researchers in Estonian academia. We use nine focus groups interviews conducted in 2015 with representatives of social sciences in order to identify early career researchers’ needs with respect to support, frustrations they may experience, and resources they may have for addressing them. Our crucial contribution is the identification of wider support networks of peers and colleagues that may compensate, partially or even fully, for failures of official supervision. (...) On the basis of our analysis we argue that support for early career researchers should take into account the resources they already possess but also recognise the importance of wider academic culture, including funding and employment patterns, and the roles of supervisors and senior researchers in ensuring successful functioning of support networks. Through analysing the conditions for the development of early career researchers – producers of knowledge – our paper contributes to social epistemology understood as analysis of specific forms of social organisation of knowledge production. (shrink)

ExcerptWith the acceptance of race-based discrimination the entire front of Italian culture has collapsed. Vittorio Foa, letter, November 20, 19381This essay will focus on one specific aspect in the attitude of intellectuals toward anti-Semitism in Italy: not the “theoretical” aspect (by which I mean their ideological support or their propaganda contributions to the anti-Jewish campaign, although those too were significant), but the practical one, i.e., their individual and collective behavior in the face of the bureaucratic process through which the anti-Jewish (...) legislation was applied in the field of high culture. As recent research has shown,…. (shrink)

The Australian state of Victoria legalised voluntary assisted dying in June 2019. Like most jurisdictions with legalised VAD, the Victorian law constructs physicians as the only legal providers of VAD. Physicians with conscientious objection to VAD are not compelled to participate in the practice, requiring colleagues who are willing to participate to transact the process for eligible applicants. Physicians who provide VAD because of their active, moral and purposeful support for the law are known as conscientious participants. Conscientious participation (...) has received scant attention in the bioethics literature. Patient access to VAD is contingent on the development of a sufficient corpus of conscientious participants in permissive jurisdictions. This article reports the findings of a small empirical study into how some Victorian physicians with no in-principle opposition towards the legalisation of VAD, are ethically orientating themselves towards the law, in the first 8 months of the law’s operation. It finds that in-principle-supportive physicians employ bioethical principles to justify their position but struggle to reconcile that approach with the broader medical profession’s opposition. This study is part of the first tranche of empirical research emerging from Australia since the legalisation of VAD in that country for the first time in over 20 years. (shrink)

Just as burnout is manifested through changes in behavioural and communication patterns, it is important to examine whether certain aspects of communication can affect student burnout development. Therefore, this study aims to investigate the relationship between communication and academic burnout. To achieve this, the study proposes an integrated model examining the effects of three communication dimensions – support from academic staff, support from colleagues, and participation in decision-making – on four different dimensions of academic burnout, as well as students’ (...) overall burnout. The model is tested using structural equation modelling (SEM) analysis. High coefficients of determination regarding particular burnout dimensions validate the strength of the proposed model. The results show that support from academic staff and support from fellow students significantly and negatively influence academic burnout, and might be instrumental in its reduction. Unexpectedly, participation in decision-making is shown to be positively related to academic burnout. (shrink)

This article explores the attitudes of consultants in a large UK teaching hospital to the need for formal clinical ethics support. Data obtained through an anonymous online questionnaire illustrate the ways in which consultants deal with clinical ethical dilemmas and their confidence in such decision-making. In the absence of formal ethics support a large proportion of consultants who took part in the survey said that they would consult with colleagues when faced with a clinical ethical dilemma and the majority (...) considered that this satisfactorily resolved the issue. However, 80% of respondents stated that they would find a form of ethics support within the Trust to be useful. Consultants also noted the reasons for, and barriers to, using ethics support. The response rate to the survey was low, perhaps indicating a lack of interest in the topic or that clinical ethics discussion is of low priority. (shrink)

Background Ethical conflicts generate difficulties in daily clinical activity. Which methods of ethical advice are most frequently used to resolve them among Spanish doctors has not been studied. The objective of this study is to describe what methods hospital internal medicine physicians in Spain use to resolve their ethical doubts and which they consider most useful. Design A cross-sectional observational study was conducted through a voluntary and anonymous survey and distributed through an ad hoc platform of the Spanish Society of (...) Internal Medicine. Measures We measured methods by which to resolve doubts, types of tools sought, frequency of consulting the Clinical Ethics Committees, and satisfaction with resolution of ethical issues. Results Of 261 internists surveyed, 86 per cent resolve their ethical doubts with assistance, the most frequently used method being consultation with colleagues (58.6 per cent), followed by using specific protocols or guides (11.8 per cent) and consultation with experts in bioethics (9.6 per cent). The most preferred tools are the creation of protocols (30.3 per cent) and the establishment of a consultant/expert in bioethics (27.8 per cent). Conclusions Internists in Spain usually seek assistance to resolve their ethical doubts. Consulting colleagues is the most frequently adopted method. The majority regard tools to resolve ethical conflicts as necessary, seeking above all protocols and consultants/experts in bioethics. (shrink)

Following surveys identifying the need for ongoing learning in relation to law and ethics amongst health professionals, the Law and Ethics Education and Development initiative was launched. This was a programme of education designed for, and delivered to, health professionals working within the National Health Service , UK, with the added value of multiprofessional learning amongst colleagues from a single institution. The initiative was funded by the NHS Executive and provided for two lecturers to work for three years within (...) the northwest region. The lecturers, an academic lawyer based at the University of Liverpool, and an ethicist based at the University of Manchester worked in collaboration through the auspices of the Institute of Medicine Law and Bioethics. A central …. (shrink)

In the context of office work, learning to handle an Enterprise Resource Planning system is important as implementation costs for such systems and associated expectations are high. However, these expectations are often not met because the users are not trained adequately. Electronic Performance Support Systems are designed to support employees’ ERP-related problem-solving and informal learning. EPSS are supposed to enhance employees’ performance and informal workplace learning through task-specific and granular help in task performance and problem-solving. However, there is little empirical (...) research on EPSS. Two survey studies addressed this research gap. In the first study, 301 people working in Human Resource -related positions and functions evaluated the learning potential of EPSS as well as potential advantages and obstacles concerning the implementation and use of EPSS. Though other measures are currently assessed as more important for learning, HR employees expect a strong increase in the significance of EPSS for employee learning. In the second study, 652 users of ERP software completed a questionnaire on characteristics of their daily work tasks, team characteristics, individual dispositions, their coping with ERP-related problems, and characteristics of EPSS. Findings indicate that the most frequently available and used approach when dealing with an ERP-related problem is consulting colleagues. Three EPSS types can be distinguished by their increasing integration into the user interface and their context-sensitivity. While external and extrinsic EPSS are available to many users, intrinsic EPSS are less common but are used intensively if available. EPSS availability is identified to be a strong positive predictor of frequency of EPSS use, while agreeableness as well as the task complexity and information-processing requirements show small negative effects. Moreover, more intensive ERP users use EPSS more frequently. In general, ERP users value, features such as context-sensitivity, an integration of the EPSS into the ERP system’s user interface, the option to save one’s own notes, and information displayed in an extra window. It is expected that EPSS will play an important role in workplace learning in the future, along with other measures. (shrink)

Will the Sarbanes-Oxley Act of 2002 and the emerging EU auditing standards be adequate to stop major corporate scandals? Certainly they will help, but the best defence against fraud is a corporate culture strong enough to itself stop abuse internally. Activities imposed from the outside can never match the role of colleagues within a company who challenge one another to maintain the highest of ethical standards and good business practices. Boards must ensure a strong ethics framework of appropriate behaviour. (...) Since behaviour is based on values priorities, a mutual effort at all levels to deal with corporate ethics begins with a clear understanding of core values, both individually and organisationally. If a company wants to achieve a high Return on Capital Employed and Customers Engaged, a high Return on Competencies Enhanced, and a high Return on Co-Creative Energy, it is a major breakthrough to discover the interrelationship between: value, values, valuing and valuation. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Burma’s Healthcare Under Fire: My Experience as an Exiled Medical ProfessionalP. P. KyawI used to work as a medical doctor in a less developed state than many big cities in Burma1 that experienced prolonged civil wars and current similar atrocities decades before the urban areas of the country experienced them. Before everything started, I was responsible for the medical management of the most vulnerable communities and had been struggling (...) with pandemic-related medical activities. Those were the happiest years of my life. I was with one of the best international organizations, where every effort I made was directly delivered to the patients with no unnecessary paperwork. The system was efficient, my colleagues were supportive, and I had a good work-life balance. I supported my family and whoever needed temporary financial support, played music weekly, met good friends who I hung out with every weekend, and [End Page 164] found hobbies like gardening and crocheting. I was content and happy. I even postponed my plans to get registered as a doctor in the Western world.Before moving to this beautiful ethnic state in 2019, I previously worked as a government medical doctor in Yangon, the capital. As much as I loved working in those civilian hospitals, I could not support myself with a monthly pay of $100-$150 USD. It was a hard decision to leave the service because it meant I could not pursue the medical specialty that I had always longed for and had to leave like-minded supportive colleagues. In Myanmar, unless you are a civil servant, you cannot pursue further clinical specialties. However, after leaving the government’s service to work in humanitarian medical assistance in hard-to-reach areas of Burma, I learned that life is still beautiful outside my comfort zone, until February 2021 when the coup began. Democratically elected members of the country’s ruling party were overthrown by the military, which then bestowed power in a military junta.I expected the election prior to the coup in November 2020 to be an uphill battle for Burma, but nothing more. I was still in denial when I first heard the news from one of the town’s NGO staff. The person had to travel on a motorbike to inform everyone that the junta had staged the coup. No telephone or internet was working at that time. My colleagues and I cried in our office, saying, “We are so young, and the future is still ahead. I don’t think this is going to last long. Maybe it will be over in a few days or, at most, a few weeks.” Once the peaceful protests started nationwide, my friends and I provided medical cover for the protesters, initially for minor medical problems such as low sugar, low blood pressure, injuries from accidental minor slips and falls, etc. Never in my life had I imagined that I would be taking care of bullet wounds and people injured by live rounds. While learning about gunshot wounds in forensic medicine, I thought, “Oh, this is not going to be very useful because Burma is not America, and I am not going there.” Then suddenly, it became too real and more useful than I would’ve liked it to be.I always think back to one especially bloody day when many people in the town were shot with live rounds. We assisted many patients. Usually, we would go around with the protest groups until they were over in the late afternoon. The protesters were always peaceful. There were no riots, no harmful acts, or vandalism. Only when the protesters were cruelly dispersed with tear gas, high-pressure pumps, rubber bullets, and live rounds (to the head) did they decide to defend themselves while still making their voices heard. The only defenses people had to counteract the live rounds were things like metal covers, firecrackers, and slingshots.One afternoon in March 2021, my team and I took an early break for lunch—unaware that some people would lose their lives that afternoon. We followed the local protests through Facebook Live while having lunch and started to hear firecracker sounds. A few seconds later, we knew... (shrink)

Workplaces are often described as places in which individuals are motivated by their self-interests and in which negative events like time pressure, anxiety, conflict with co-workers, miscomprehensions, difficulties in solving problems, not-transmitted or not-exchanged information that lead to mistakes, and in some cases to injuries, stress or control, are part of everyday life. Such situations are often the result of the limited comprehension of needs, skills, or information available to colleagues, supervisors, subordinates, clients or providers. However, workplaces are also (...) places in which employees take care of clients, support colleagues and subordinates, are enthusiastic about their job, are motivated by leaders that encourage employees to transcend their own self-interests for the good of the group or the organization and provide them with the confidence to perform beyond expectations. Thus positive relationships at work are becoming a new interdisciplinary domain of inquiry. Within this positive relationships framework, in this paper we focus on a positive component of workplaces, and particularly on an individual cognitive and emotional process that has an important role in the workplace because it facilitates interpersonal relations and communications: it is the perspective taking process. In order to describe perspective taking, we will refer to some empirical studies and particularly to the review published by Parker, Atkins and Axtell in 2008 on the International Review of Industrial and Organizational Psychology. Perspective taking is a well established psychological construct, investigated both in the field of human development, as an important component of reasoning and moral development, and also in social and clinical psychology, where it is considered a component of social behaviors and of the therapeutic process. It has also been conceptualized in different ways. Duan and Hill describe three approaches to explain reasons for perspective taking behavior: a dispositional approach, that considers empathy as a relatively stable trait or a general ability; a cognitive-affective experience influenced by situational conditions; and finally as a multiphased experiential process. However, although in modern organizations working cooperatively and taking into account customers’ needs and experiences are becoming even more important, very few studies have considered perspective taking process within organizations. This is interesting because taking into account the perspective of others may contribute to more collaborative workplaces, where it is pleasant to work, as also enlighted in the title of the Parker, Atkins and Axtell’s paper: “Building better workplaces” is one of the possible outcomes of perspective taking. This paper aims to make available to a large audience such studies and, in relation to the topic of the conference organized by “Psychology and Communion”, consider connections between this concept and ideas and writings by Chiara Lubich. (shrink)

Background: Organizational climate refers to an individual's perception and experience of the climate of the work environment, and it is the most important environmental variable that affects individuals’ work performance. This study aims to classify characteristics of transformational leadership among kindergarten principals and examine their relationship to organizational climate. Methods: Convenience sampling yielded 498 kindergarten principals who completed the “Questionnaire on the Principal’s Transformational Leadership Behavior” and “Questionnaire on Organizational Climate.” Ethics approval was obtained from the Academic Ethics Committee of (...) the College of Psychology of Northeast Normal University prior to starting the study. Results: Three latent classes were identified, including the high-level (68.8%), care-virtues (35.7%), and virtues groups (5.3%). There were significant differences in support, directive, restrictive, colleague, intimate, and disengaged behavior scores between groups. In terms of support, colleague, and intimate behavior, the high-level group had the highest scores, followed by the care-virtues group and virtues group, respectively. Regarding restrictive and disengaged behavior, the highest scores were received by the virtues group, followed by the care-virtues and high-level group, respectively. Conclusion: The study suggested that principals’ transformational leadership could be classified into three latent classes that are related to organizational climate. (shrink)

: Burnout is a psychology syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment. The participants of this study are nurses who have been working at intensive care unit at least for one year. Data were obtained using questionnaire and processed using spearman correlation. Results indicate that are negative relationship between emotional exhaustion and depersonalization with perceived support from colleagues. However, this research finds no relationship between reduced personal accomplishment and perceived support from colleagues. Key words : Burnout, (...) perceived support from colleagues, intensive care nurses. (shrink)

Organizational citizenship behavior (OCB) is considered vital for organizations’ performance, and there is notable interest in factors that foster it. However, recent research has questioned the absolute positivity of OCB and pointed to its understudied possible adverse effects (e.g., on employees’ well-being). The present research aims to shed light on these issues by exploring the daily dynamics of employees’ social and emotional work lives’ interplay with their OCB. Specifically, the research focuses on teachers, whose job enables notable OCB and whose (...) performance is profoundly affected by it. Based on the literature linking work relationships and emotional experiences with OCB, we examined the interplay between teachers’ OCB and their daily perceived supervisor and colleague support, and daily positive and negative emotional experiences. Sixty teachers completed self-report questionnaires of the research variables every day for twelve workdays. Results indicated significant associations of daily supervisor support and negative emotions with increased OCB on the following day, links of daily positive emotions with decreased OCB on the following day, and associations of daily OCB with increased negative emotions on the following day. These findings point to daily processes that may underly longer-term effects of OCB (such as burnout), including a potential downward spiral of negative emotions that seem to result from OCB and reinforce it. (shrink)

Authors De Marco and colleagues have presented a new model on the concept of invasiveness, redefining both its technical definition and practical implementation.1 While the authors raise valid critiques regarding the discrepancy in definitions, I cannot help but wonder about the purpose of redefining terms for which little confusion, if any, exists? This commentary seeks to scrutinise the rationale supporting the new model in the absence of significant clinical confusion and to explore the implications for clinical practice. Initially, (...) one may notice there is no mention of clinical relevancy, confusion among patients or whether the discrepancy in terms is causing miscommunication. It seems reasonable that some clinical confusion may exist, but so too does a similar imbalance of terms when speaking technically across the specialties; take depression and its definition as a primary example. While I certainly agree with the illustration of non-invasive prenatal testing being compared with venous blood draws as a disparity in terminology, little evidence suggests confusion concerning the nosology.2 The medical community, including both physicians and patients, recognises that the terminology is specifically used within the …. (shrink)

Background Supporting physicians in Intensive Care Units s as they face dying patients at unprecedented levels due to the COVID-19 pandemic is critical. Amidst a dearth of such data and guided by evidence that nurses in ICUs experience personal, professional and existential issues in similar conditions, a systematic scoping review is proposed to evaluate prevailing accounts of physicians facing dying patients in ICUs through the lens of Personhood. Such data would enhance understanding and guide the provision of better support (...) for ICU physicians. Methods An SSR adopts the Systematic Evidenced Based Approach to map prevailing accounts of caring for dying patients in ICUs. To enhance the transparency and reproducibility of this process, concurrent and independent use of tabulated summaries, thematic analysis and directed content analysis is adopted. Results Eight thousand three hundred fifty-eight abstracts were reviewed from four databases, 474 full-text articles were evaluated, 58 articles were included, and the Split Approach revealed six categories/themes centered around the Innate, Individual, Relational and Societal Rings of Personhood, conflicts in providing end of life care and coping mechanisms employed. Conclusion This SSR suggests that caring for dying patients in ICU impacts how physicians view their personhood. To resolve conflicts within individual concepts of personhood, physicians use prioritization, reframing and rely on accessible, personalized support from colleagues to steer coping strategies. An adapted form of the Ring Theory of Personhood is proposed to direct timely personalized, appropriate and holistic support. (shrink)

Kevin Laland and colleagues have put forward a number of arguments motivating an extended evolutionary synthesis. Here I examine Laland et al.'s central concept of reciprocal causation. Reciprocal causation features in many arguments supporting an expanded evolutionary framework, yet few of these arguments are clearly delineated. Here I clarify the concept and make explicit three arguments in which it features. I identify where skeptics can—and are—pushing back against these arguments, and highlight what I see as the empirical, explanatory, (...) and methodological issues at stake. (shrink)

Young and colleagues . Betwixt life and death: case studies of the Cotard delusion. In P. W. Halligan & J. C. Marshall , Method in madness: Case studies in cognitive neuropsychiatry. Mahway, NJ: Lawrence Erlbaum Associates.) have suggested that cases of the Cotard delusion result when a particular perceptual anomaly occurs in the context of an internalising attributional style. This hypothesis has not previously been tested directly. We report here an investigation of attributional style in a 24-year-old woman with (...) Cotard delusion . LU’s attributional style was assessed using the Internal, Personal and Situational Attributions Questionnaire . A new measure of causal locus: the internal, personal and situational attributions questionnaire. Personality and Individual Differences, 20, 261–264.). LU showed a significantly greater proportion of internalising attributions than the control group, both overall and for negative events specifically. The results obtained thus support an association of Cotard delusion with an internalising attributional style, and are therefore consistent with the account of Young and colleagues. The potential brain basis of Cotard delusion is discussed. (shrink)

: Research by Siminoff and colleagues reveals that many lay people in Ohio classify legally living persons in irreversible coma or persistent vegetative state (PVS) as dead and that additional respondents, although classifying such patients as living, would be willing to procure organs from them. This paper analyzes possible implications of these findings for public policy. A majority would procure organs from those in irreversible coma or in PVS. Two strategies for legitimizing such procurement are suggested. One strategy would (...) be to make exceptions to the dead donor rule permitting procurement from those in PVS or at least those who are in irreversible coma while continuing to classify them as living. Another strategy would be to further amend the definition of death to classify one or both groups as deceased, thus permitting procurement without violation of the dead donor rule. Permitting exceptions to the dead donor rule would require substantial changes in law—such as authorizing procuring surgeons to end the lives of patients by means of organ procurement—and would weaken societal prohibitions on killing. The paper suggests that it would be easier and less controversial to further amend the definition of death to classify those in irreversible coma and PVS as dead. Incorporation of a conscience clause to permit those whose religious or philosophical convictions support whole-brain or cardiac-based death pronouncement would avoid violating their beliefs while causing no more than minimal social problems. The paper questions whether those who would support an exception to the dead donor rule in these cases and those would support a further amendment to the definition of death could reach agreement to adopt a public policy permitting organ procurement of those in irreversible coma or PVS when proper consent is obtained. (shrink)

I compare Frith and colleagues’ influential comparator account of how the sense of agency is elicited to the multifactorial weighting model advocated by Synofzik and colleagues. I defend the comparator model from the common objection that the actual sensory consequences of action are not needed to elicit the sense of agency. I examine the comparator model’s ability to explain the performance of healthy subjects and those suffering from delusions of alien control on various self-attribution tasks. It transpires that (...) the comparator model needs case-by-case adjustment to deal with problematic data. In response to this, the multifactorial weighting model of Synofzik and colleagues is introduced. Although this model is incomplete, it is more naturally constrained by the cases that are problematic for the comparator model. However, this model may be untestable. I conclude that currently the comparator model approach has stronger support than the multifactorial weighting model approach. (shrink)

Registered nurses (RNs) employed in an urban medical center in the USA identified moral distress as a practice concern. This study describes RNs' moral distress and the frequency of morally distressing events. Data were collected using the Moral Distress Scale and an open-ended questionnaire. The instruments were distributed to direct-care-providing RNs; 100 responses were returned. Morally distressing events included: working with staffing levels perceived as `unsafe', following families' wishes for patient care even though the nurse disagreed with the plan, and (...) continuing life support for patients owing to family wishes despite patients' poor prognoses. One high frequency distressing event was carrying out orders for unnecessary tests and treatments. Qualitative data analysis revealed that the nurses sought support and information from nurse managers, chaplaincy services and colleagues. The RNs requested further information on biomedical ethics, suggested ethics rounds, and requested a non-punitive environment surrounding the initiation of ethics committee consultations. (shrink)

Henry Wellman and colleagues have provided evidence of a robust developmental progression in theory-of-mind (or as we will say, “mindreading”) abilities, using verbal tasks. Understanding diverse desires is said to be easier than understanding diverse beliefs, which is easier than understanding that lack of perceptual access issues in ignorance, which is easier than understanding false belief, which is easier than understanding that people can hide their true emotions. These findings present a challenge to nativists about mindreading, and are said (...) to support a social-constructivist account of mindreading development instead. This article takes up the challenge on behalf of nativism. Our goal is to show that the mindreading-scale findings fail to support constructivism because well-motivated alternative hypotheses have not yet been controlled for and ruled out. These have to do with the pragmatic demands of verbal tasks. (shrink)

After reading Savulescu and colleagues,1 one ought to be in no doubt that human heritable genome editing is a ‘moral imperative’: to cure disease, reduce inequalities, improve public health and protect future generations. They make this argument repeatedly and in no uncertain terms. Yet are they right to do so? I am certainly not against developing HGE or exploring its possibilities. Instead, I aim to sound a cautionary note in relation to claims about its technological potential and how we (...) frame arguments on this basis. The ‘moral imperative’ argument has been made many times, since well before the advent of genome editing, by the present authors and others. It generally rests on a number of preconditions, implicit or explicit: that HGE will be safe, effective, cost-efficient and equitably available. Now, many bioethicists would take no issue with, indeed have supported,5 the proposition that, once all of these conditions are satisfied, HGE is something we have good moral reasons to pursue. At this pivotal moment for global science, ethics and governance, however, we need equally to be concerned with the technology’s immediate future trajectory: whether and how we can reach the point of satisfying these conditions. In this context, the MIA is something of a distraction; at worst, it may even be corrosive and damaging. Consider first the argument from evolutionary fitness, that HGE is morally required to counteract the supposed ‘genetic deterioration’ produced by medically enabled ‘survival of the weak’, that makes …. (shrink)

Studies by Gardiner and colleagues connecting musical pitch and arithmetic learning support Rips et al.'s proposal that natural number concepts are constructed on a base of innate abilities. Our evidence suggests that innate ability concerning sequence ( or BSC) is fundamental. Mathematical engagement relating number to BSC does not develop automatically, but, rather, should be encouraged through teaching.

Blumenthal-Barby and colleagues (2022) argue that philosophy continues to be relevant to bioethics. To support their argument, they offer several examples of how—not philosophy, exactly—but normati...

Ferrara, Jacobson, and their colleagues illuminate how community schools become a comprehensive, place-based strategy that both supports high-quality teaching and learning and addresses out-of-school barriers to success.

According to Ramsey and colleagues the main constituent psychological processes of innovation are response to novelty, exploration, and the ability to recognize a novel solution. I fully support this view but point out that novelty reactions are often context-specific. I will expand on this and discuss the possible consequences of context-specific novelty reactions on the emergence of innovations.

Sussman and colleagues provide no evidence supporting their claim that the human vocal production system is specialized to produce locus equations with high correlations and linearity. We propose the alternative null hypothesis that these features result from physical and physiological factors common to all mammalian vocal tracts and we recommend caution in assuming that human speech production mechanisms are unique.

Goering and colleagues (2017) acknowledge closed-loop neural devices have the potential to undermine agency. Indeed, the authors observe that “the agent using the device may . . . sometimes doubt whether she is the author of her action, given that the device may operate in ways that are not transparent to her” (65). Still, the authors ultimately argue that closed-loop neural devices may be construed as supporting agency, especially when we view agency from a relational perspective. The reason? (...) We often manifest our agency in relation with others. For example, family and close friends sometimes step in to support us in setting and achieving our aims. In a similar way, then, the authors argue that “we can imagine [a closed-loop] device stepping in to support the user in achieving her aim” (67). Closed-loop neural devices, in other words, can be construed as supporting one’s agency in much the same way as other people can be seen as supporting one’s agency. The authors thus conclude that when we view agents from a relational perspective, closed-loop neural devices may be viewed as supporting rather than undermining agency. I largely agree with the authors’ conclusion. I also believe, however, that their discussion can be clarified by distinguishing three kinds of agency and viewing closed-loop neural devices from the perspective of each. By thinking carefully about agency, we can see more clearly the ways in which it is undermined by closed-loop neural devices, as well as the way in which these devices may support agency. (shrink)

Suppose some person 'A' sets out to accomplish a difficult, long-term goal such as writing a passable Ph.D. thesis. What should you believe about whether A will succeed? The default answer is that you should believe whatever the total accessible evidence concerning A's abilities, circumstances, capacity for self-discipline, and so forth supports. But could it be that what you should believe depends in part on the relationship you have with A? We argue that it does, in the case where A (...) is yourself. The capacity for "grit" involves a kind of epistemic resilience in the face of evidence suggesting that one might fail, and this makes it rational to respond to the relevant evidence differently when you are the agent in question. We then explore whether similar arguments extend to the case of "believing in" our significant others -- our friends, lovers, family members, colleagues, patients, and students. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Response 4: The Summer of Our DiscontentCaroline EdwardsI write this response on the eve of another wave of industrial action in the UK in November 2022—the Universities and Colleges Union (UCU) “UCU Rising” campaign, the latest in a series of regular disputes over pay and working conditions, the gender and ethnicities pay gap, and casualisation that has been ongoing since 2018. In 2022’s “summer of discontent,” we’ve seen our (...) rail, maritime and transport workers, airport staff, bus drivers, telecommunications workers, postal workers, nurses, refuse workers, and higher and further education staff engage in ongoing industrial disputes with intractable bosses. Even criminal barristers continue with an indefinite, uninterrupted strike after years of government cuts and chronic underinvestment. Everywhere you look, there is a palpable sense of a country on its knees. It’s nearly 100 years since the last General Strike of 1926 and in the UK it’s looking increasingly likely that we will have another General Strike on our hands soon. In “Two Cheers for Blueprints, or, Negative Reasons for Positive Utopianism” Antonis Balasopoulos contextualizes this within the longer economic durée of the shift from Fordist production to so-called flexible accumulation after 1972, writing in this issue that “the turn of capital to the faster and higher [End Page 554] profits involved in financialization rather than infrastructural and industrial investment, form much of the objective, structural ground for what can only be described as the rapid rise of a dystopian structure of feeling in western societies since the early 1970s.” Antonis’s brilliant summary reminds us of the monumental scale of the challenges facing utopian thought and praxis in our current moment. Make no mistake—the “crisis ordinariness” of everyday life under late capitalism that Lauren Berlant identified in Cruel Optimism (2011) has intensified in the years following the Global Financial Crisis (2007–8), the wave of Occupy protests in 2011, and, more recently, the COVID-19 pandemic (2020–). “For some time now,” as Antonis writes, the utopian goals of “happiness, fulfilment, [and] emancipation... have been out of the question altogether.”It’s hard not to agree with this assessment, given the current chaos of life in the UK. Adam Stock’s roundtable contribution “Funding Utopia: Utopian Studies and the Discourse of Academic Excellence” focuses on the academy’s complicity with the neoliberal financialization of what were previously protected as public goods (education, our health service, transport infrastructure, and so on) over the past three decades. As Adam notes, the rhetoric of “excellence” that has come to dominate all areas of university life—teaching, research, public engagement, and the quantifiable “impact” of university research beyond the academy—is really just another way of using competition to mask the market logic of scarcity. Swingeing cuts to publicly funded research have led to a scarcity of resources in scholarly knowledge production, which is legitimated through the discourse of “excellence” and “prestige.” Only a handful of elite research leaders are granted awards and the value of all research becomes judged by its proximity to this distribution (concentration) of wealth within a small number of institutions. Defending education as a public good has long given way to the desperate, existential struggle for survival at UK universities. Numerous institutions are on the brink of bankruptcy, which was the goal all along for the ideologically driven Office for Students (OfS). Market exit, as they euphemistically term it, proves market efficiency.At my own institution, Birkbeck, University of London, the challenge to utopian thinking is all too violently clear. Birkbeck has a special place in the UK higher education system—a university founded nearly 200 years ago in the Crown and Anchor Tavern on the Strand (it was called the London Mechanics’ Institution back then) to offer education to working-class Londoners that [End Page 555] fitted around their busy working lives. As my colleague Joanna Bourke writes in Birkbeck: 200 Years of Radical Learning for Working People (2022), life expectancy in the poorest parts of London was just twenty-nine years; cholera, typhoid, and typhus were major killers; and illiteracy was widespread. At Birkbeck, we are the only university to teach evening classes and offer the requisite support... (shrink)

Explaining the behaviour of ecosystems is one of the key challenges for the biological sciences. Since 2000, new-mechanicism has been the main model to account for the nature of scientific explanation in biology. The universality of the new-mechanist view in biology has been however put into question due to the existence of explanations that account for some biological phenomena in terms of their mathematical properties (mathematical explanations). Supporters of mathematical explanation have argued that the explanation of the behaviour of ecosystems (...) is usually provided in terms of their mathematical properties, and not in mechanistic terms. They have intensively studied the explanation of the properties of ecosystems that behave following the rules of a non-random network. However, no attention has been devoted to the study of the nature of the explanation in those that form a random network. In this paper, we cover that gap by analysing the explanation of the stability behaviour of the microbiome recently elaborated by Coyte and colleagues, to determine whether it fits with the model of explanation suggested by the new-mechanist or by the defenders of mathematical explanation. Our analysis of this case study supports three theses: (1) that the explanation is not given solely in terms of mechanisms, as the new-mechanists understand the concept; (2) that the mathematical properties that describe the system play an essential explanatory role, but they do not exhaust the explanation; (3) that a non-previously identified appeal to the type of interactions that the entities in the network can exhibit, as well as their abundance, is also necessary for Coyte and colleagues’ account to be fully explanatory. From the combination of these three theses we argue for the necessity of an integrative pluralist view of the nature of behaviour explanation when this is given by appealing to the existence of a random network. (shrink)

Existence of state-supported academies of science is a distinctive feature of the fundamental-science organization in Ukraine. Their research staff is divided into two groups: (i) personal members (academicians and corresponding members) and the rest of the researchers. First-group members have numerous economic and status privileges. It is officially purported that personal members are scientifically qualified than their colleagues. We analyzed this hypothesis on the basis of international indicators of the scientifi c activity (numbers of publications in the international peer-reviewed (...) journals and citations in them). The indicators testify that there are no distinctions between representatives of both groups being of the same age and qualifi cation. A conclusion is made that the lifelong privileges of the first group are ill-founded. (shrink)

An important and supposedly impactful form of clinical ethics support is moral case deliberation. Empirical evidence, however, is limited with regard to its actual impact. With this literature review, we aim to investigate the empirical evidence of MCD, thereby a) informing the practice, and b) providing a focus for further research on and development of MCD in healthcare settings. A systematic literature search was conducted in the electronic databases PubMed, CINAHL and Web of Science. Both the data collection and the (...) qualitative data analysis followed a stepwise approach, including continuous peer review and careful documentation of our decisions. The qualitative analysis was supported by ATLAS.ti. Based on a qualitative analysis of 25 empirical papers, we identified four clusters of themes: 1) facilitators and barriers in the preparation and context of MCD, i.e., a safe and open atmosphere created by a facilitator, a concrete case, commitment of participants, a focus on the moral dimension, and a supportive organization; 2) changes that are brought about on a personal and inter-professional level, with regard to professional’s feelings of relief, relatedness and confidence; understanding of the perspectives of colleagues, one’s own perspective and the moral issue at stake; and awareness of the moral dimension of one’s work and awareness of the importance of reflection; 3) changes that are brought about in caring for patients and families; and 4) changes that are brought about on an organizational level. This review shows that MCD brings about changes in practice, mostly for the professional in inter-professional interactions. Most reported changes are considered positive, although challenges, frustrations and absence of change were also reported. Empirical evidence of a concrete impact on the quality of patient care is limited and is mostly based on self-reports. With patient-focused and methodologically sound qualitative research, the practice and the value of MCD in healthcare settings can be better understood, thus making a stronger case for this kind of ethics support. (shrink)

Introduction: Evidence supporting the use of music interventions to maximize arousal and awareness in adults presenting with a disorder of consciousness continues to grow. However, the brain of a child is not simply a small adult brain, and therefore adult theories are not directly translatable to the pediatric population. The present study aims to synthesize brain imaging data about the neural processing of music in children aged 0-18 years, to form a theoretical basis for music interventions with children presenting (...) with a disorder of consciousness following acquired brain injury.Methods: We conducted a systematic review with narrative synthesis utilizing an adaptation of the methodology developed by Popay and colleagues. Following the development of the narrative that answered the central question “what does brain imaging data reveal about the receptive processing of music in children?”, discussion was centered around the clinical implications of music therapy with children following acquired brain injury.Results: The narrative synthesis included 46 studies that utilized EEG, MEG, fMRI, and fNIRS scanning techniques in children aged 0-18 years. From birth, musical stimuli elicit distinct but immature electrical responses, with components of the auditory evoked response having longer latencies and variable amplitudes compared to their adult counterparts. Hemodynamic responses are observed throughout cortical and subcortical structures however cortical immaturity impacts musical processing and the localization of function in infants and young children. The processing of complex musical stimuli continues to mature into late adolescence.Conclusion: While the ability to process fundamental musical elements is present from birth, infants and children process music more slowly and utilize different cortical areas compared to adults. Brain injury in childhood occurs in a period of rapid development and the ability to process music following brain injury will likely depend on pre-morbid musical processing. Further, a significant brain injury may disrupt the developmental trajectory of complex music processing. However, complex music processing may emerge earlier than comparative language processing, and occur throughout a more global circuitry. (shrink)

Venneman and colleagues argue that “do not resuscitate” (DNR) is problematic and should be replaced by “allow natural death” (AND). Their argument is flawed. First, while end-of-life discussions should be as positive as possible, they cannot and should not sidestep painful but necessary confrontations with morality. Second, while DNR can indeed be nonspecific and confusing, AND merely replaces one problematic term with another. Finally, the study’s results are not generalisable to the populations of physicians and working nurses and certainly (...) do not support the authors’ claim that there is a movement to replace DNR with AND. (shrink)

Background Moral distress has negative effects on physical and mental health. However, there is little information about nurses’ coping strategies reducing moral distress. Aim The purpose of this study was to investigate the coping strategies of intensive care unit nurses reducing moral distress in Iran. Study design This is a qualitative study with a content analysis approach. Participants and research context The research sample consisted of nurses working in intensive care units of teaching hospitals affiliated to Tehran University of Medical (...) Sciences. Samples were selected among eligible nurses by purposive sampling. Data were obtained through 17 in-depth, individual, and semi-structured interviews with 17 nurses. Graneheim and Lundman’s (2004) 6-step content analysis method was used to analyze the data. Data management was also performed by MAXQDA software version 20. The COREQ checklist was used to report the study. Ethical considerations This project was approved by the Ethics Committee of Tehran University of Medical Sciences. All ethical guidelines in research were followed. Finding The data analysis resulted in the formation of two main categories of desirable coping strategies (with two subcategories of compensation and rejuvenation) and less desirable coping strategies (with three subclasses of indifference over time, escape and concealment). Discussion The intensive care unit nurses in dealing with ethical problems first try to solve the problem through discussion, but when they fail to resolve it peacefully, they resort to several coping strategies. Factors, such as increasing experience, lack of support from hospital managers and officials, poor communication between colleagues, the need to maintain hierarchy, fear of reprimand, and a sense of powerlessness, changed the nurses’ preferred strategies. It is important for managers to provide a blame/punishment-free atmosphere for expression of ethical experiences; a supportive atmosphere in which staff can engage in ethical discussions without fear of punishment. They should also provide opportunities for rest, rejuvenation, and adequate training for their employees. (shrink)

Childress and colleagues (2023) review several arguments that would support the unilateral withdrawal of ECMO (extracorporeal membrane oxygenation) against the wishes of a capacitated patient (Mr....