Moral distress (MD) is well-documented within the nursing literature and occurs when constraints prevent a correct course of action from being implemented. The measured frequency of MD has increased among nurses over recent years, especially since the COVID-19 Pandemic. MD is less understood among nurse leaders than other populations of nurses. A qualitative systematic review was conducted with the aim to synthesize the experiences of MD among nurse leaders. This review involved a search of three databases (Medline, CINAHL, and APA (...) PsychINFO) which resulted in the retrieval of 303 articles. PRISMA review criteria guided authors during the article review and selection process. Following the review, six articles were identified meeting review criteria and quality was assessed using the Critical Appraisal Skills Programme (CASP) Checklist for qualitative studies. No ethical review was required for this systematic review. The six studies included in this review originated from the United States, Brazil, Turkey, and Iran. Leadership roles ranged from unit-based leadership to executive leadership. Assigned quality scores based upon CASP criteria ranged from 6 to 9 (moderate to high quality). Three analytical themes emerged from the synthesis: (1) moral distress is consuming; (2) constrained by the system; and (3) adapt to overcome. The unique contributors of MD among nurse leaders include the leadership role itself and challenges navigating moral situations as they arise. The nurse leader perspective should be considered in the development of future MD interventions. (shrink)

This illustrated series exhibits biographical accounts of the great people of all time. 'People of Importance' includes a variety of figures, such as Vincent Van Gogh, Mother Teresa, Archimedes, Confucius, Dalai Lama, and Marco Polo.

Kristeva's Teresa My Love concerns the life and thought of a 16th century Spanish mystic, written in the form of a novel. Yet the theme of another kind of foreigner, equally exotic but this time threatening, pops up unexpectedly and disappears several times during the course of the novel. At the very beginning of the story, the 21st century narrator, psychoanalyst Sylvia Leclerque, encounters a young woman in a headscarf, whom Kristeva describes as an IT engineer, who speaks out, (...) explaining that "she and her God were one and that the veil was the immovable sign of this 'union,' which she wished to publicize in order to definitively 'fix it' in herself and in the eyes of others." In this paper I ask what difference Kristeva discerns between these two women, a distinction that apparently makes Teresa's immanence simultaneously a transcendence, but transforms a Muslim woman in a headscarf immediately into an imagined suicide bomber. Despite the problematic aspects of this comparison, we can learn something from them about Kristeva's ideas on mysticism and on art. Both mysticism and art are products of the death drive, but whereas the suicide bomber and the animal directly and purely pursue death Teresa and Adel remain on its outer edge and merely play with mortality. (shrink)

Prompted and ever diversified by the specifically human interrogative logos, scientific inquiries seek a common system of links in order to mutually confirm and rectify their results. Coming closer and closer to phenomenology, the sciences of life find the common ground of the reality in the ontopoiesis of life. Could it not be that the interrogative logos of science, participating in human creative inventiveness will bring together also the divergent scientific methods in a common network? A network which comprises natural (...) processes, societal sharing-in-life, and existential communication. Papers by: Gary Backhaus, Anjana Bhattacharjee, Simon Du Plock, Ignacy Fiut, Maria Golaszewska, Wendy C. Hamblet, Alexandr Kouzmin, Nikolay Kozhevnikov, Olga Louchakova, Jarlath Mc Kenna, Amy Louise Miller, Aria Omrani, Arthur Piper, Leszek Pyra, W. Kim Rogers, A.L. Samian, Camilo Serrano Bonitto, Natalia Smirnova, Eva Syristova, Anna-Teresa Tymieniecka, Roberto Verolini, Eldon C. Wait, Leo Zonneveld. (shrink)

Payment for research participation has raised ethical concerns, especially with respect to its potential for coercion. We argue that characterising payment for research participation as coercive is misguided, because offers of benefit cannot constitute coercion. In this article we analyse the concept of coercion, refute mistaken conceptions of coercion and explain why the offer of payment for research participation is never coercive but in some cases may produce undue inducement.

John McMillan's article raises numerous important points about the ethics of surgical castration of sex offenders.1 In this commentary, we focus solely on and argue against the claim that the offer of release from detention conditional upon surgical castration is a coercive offer that compromises the validity of the offender's consent. We take no view on the question as to whether castration for sex offenders is ethically permissible. But, we reject the claim that it is ethically permissible only if competing (...) ethical considerations outweigh worries about coercion. For in the situation described, the proposal is not coercive at all.McMillan states that if offenders agree to castration because they fear long-term detention, then ‘it seems, intuitively, as if agreeing to be castrated under these conditions makes the decision coerced in some way.’1 He adds that if castration is ‘the only way that they will be released back into the community, the status of this decision as a genuine expression of their autonomy is questionable.’1 In defence of his claim, he uses two analogies that he borrows from Joel Feinberg. First, if a governor offers to commute a death sentence if the prisoner agrees to participate in a medical experiment, then ‘it's clear that the governor is coercing the prisoner.’1 Second, if a millionaire offers to give a woman $1 000 000 …. (shrink)

A remarkable collection of interviews and dialogues that discuss culture, ideology, history, Marxism, modernity, post-modernity, post-colonialism, globalization, and the role of the university and the intellectual in today's society.

The importance of patients taking an active role in their healthcare is recognized internationally, to improve safety and effectiveness in practice. There is still, however, some ambiguity about the conceptualization of that patient role; it is referred to interchangeably in the literature as engagement, involvement, and participation. The aim of this discussion paper is to examine and conceptualize the concepts of patient engagement, involvement, and participation within healthcare, particularly nursing. The concepts were found to have semantic differences and similarities, although, (...) from a nursing perspective, they can be summoned to illustrate the establishment of a mutual partnership between a patient and a nurse. The individualization of such processes requires the joint effort of engagement, involvement, or participation, represented by interactive actions of both the patient (asking questions, telling/speaking up, knowledge acquisition, learning, and decision‐making) and the nurse (recognizing, responding, information sharing, teaching, and collaborating). Suggesting that the concepts can be used interchangeably comes with some caution, requiring that nurses embrace patients playing a role in their health and healthcare. Further research and practice development should focus on how patients and nurses receive and respond to each other to establish patient engagement, involvement, and participation. (shrink)

The idea that our conscious decisions determine our actions has been challenged by a report suggesting that the brain starts to prepare for a movement before the person concerned has consciously decided to move . Libet et al. claimed that their results show that our actions are not consciously initiated. The current article describes two experiments in which we attempted to replicate Libet et al.'s comparison of participants' movement-related brain activity with the reported times of their decisions to move and (...) also the reported times of their decisions of which hand to move. We also looked at the distribution of participants' reports over time to evaluate an alternative explanation of Libet et al.'s results. Although the Readiness Potential was usually present before all of the decisions to move, consistent with the findings of Keller and Heckhausen and Libet et al. , we found that many reported decision times were before the onset of the Lateralized Readiness Potential, which measures hand-specific movement preparation. The latter finding is consistent with the conclusion that the LRP always started after the conscious decision to move. We conclude that even though activity related to movement anticipation may be present before a conscious decision to move, the cortical preparation necessary for the movement to happen immediately may not start until after the conscious decision to move. (shrink)

We argued last year in this journal that extensive integration of research and care is a worthy goal of health system design, and we second the call from Ruth Faden and colleagues to move toward learning health care systems. As they recognize, learning health care systems demand the coordination of research and medical ethics—two sets of normative commitments that have long been considered distinct. In offering a novel ethics framework for such systems, Faden et al. advance the scholarly debate about (...) how best to do this and challenge us to think more deeply about its practical implications. However, we believe that at least three issues they raise require additional attention. First, the research‐care distinction has more normative bite than they are willing to concede. Second, the role for independent oversight requires clarification. Finally, they neglect the concept of stewardship as a guiding obligation of learning health care systems. (shrink)

We argued last year in this journal that extensive integration of research and care is a worthy goal of health system design, and we second the call from Ruth Faden and colleagues to move toward learning health care systems. As they recognize, learning health care systems demand the coordination of research and medical ethics—two sets of normative commitments that have long been considered distinct. In offering a novel ethics framework for such systems, Faden et al. advance the scholarly debate about (...) how best to do this and challenge us to think more deeply about its practical implications. However, we believe that at least three issues they raise require additional attention. First, the research‐care distinction has more normative bite than they are willing to concede. Second, the role for independent oversight requires clarification. Finally, they neglect the concept of stewardship as a guiding obligation of learning health care systems. (shrink)

Business and Society Review, Volume 127, Issue S1, Page 193-222, Spring 2022.

Purpose Prescription stimulant use as “cognitive enhancers” has been described among undergraduate college students. However, the use of prescription stimulants among future health care professionals is not well characterized. This study was designed to determine the prevalence of prescription stimulant misuse among students at an academic health sciences center. -/- Method Electronic surveys were e-mailed to 621 medical, pharmacy, and respiratory therapy students at East Tennessee State University for four consecutive weeks in fall 2011. Completing the survey was voluntary and (...) anonymous. Surveys asked about reasons for, frequency of, and side effects of nonprescription misuse of prescription stimulants. Given the sensitive material, an opportunity to win one of ten $50 gift cards was used as an incentive. -/- Results Three hundred seventy-two (59.9%) students completed the survey from three disciplines (47.6% medical, 70.5% pharmacy, and 57.6% respiratory therapy). Overall, 11.3% of responders admitted to misusing prescription stimulants. There was more misuse by respiratory therapy students, although this was not statistically significant (10.9% medicine, 9.7% pharmacy, 26.3% respiratory therapy; P = .087). Reasons for prescription stimulant misuse included to enhance alertness/ energy (65.9%), to improve academic performance (56.7%), to experiment (18.2%), and to use recreationally/get high (4.5%). -/- Conclusions Prescription stimulant misuse was prevalent among participating students, but further research is needed to describe prevalence among future health care workers more generally. The implications and consequences of such misuse require further study across professions with emphasis on investigating issues of academic dishonesty (e.g., “cognitive enhancement”), educational quality, and patient safety or health care quality. (shrink)

We seek to add to the Corporate Social Responsibility (CSR) and Sustainable Development (SD) literature through the empirical study of Latin American firm membership in the United Nations Global Compact (GC) and Global Report Initiative (GRI). Within an institutional-based framework, we explore through three filters – commercial, state-signaling, and distinguished peers – the impact of normative and mimetic pressures associated with GC/gri membership. Our sample includes 207 public firms from six Latin American countries (Argentina, Brazil, Chile, Colombia, Mexico, and Peru). (...) Our results suggest Latin American firms from countries with a greater European influence (normative pressure) are twice as likely to be enrolled in the GC/gri. Additionally, we find that Latin American firms listed on the NYSE (mimetic pressure) are also twice as likely to sign up under the GC/gri. Hence, the normative and mimetic pillars of institutional theory are found to be significant factors for Latin American firms adopting sustainability initiatives. (shrink)

How can we disagree with a bald-faced liar? Can we actively disagree if it is common ground that the speaker has no intent to deceive? And why do we disapprove of bald-faced liars so strongly? Bald-faced lies pose problems for accounts of lying and of assertion. Recent proposals try to defuse those problems by arguing that bald-faced lies are not really assertions, but rather performances of fiction-like scripts, or different types of language games. In this paper, I raise two objections (...) to the fictionalist view, and then offer an analysis of how we disagree with bald-faced liars. I conclude that bald-faced lies are assertions, and that in pronouncing a bald-faced lie, the speaker tries to make it common ground that the assertion was in good standing qua assertion. (shrink)

This paper explores the possibility of developing a hybrid version of dispositional theories of aesthetic values. On such a theory, uses of aesthetic predicates express relational second-order dispositional properties. If the theory is not absolutist, it allows for the relativity of aesthetic values. But it may be objected to on the grounds that it fails to explain disagreement among subjects who are not disposed alike. This paper explores the possibility of adapting recent proposals of hybrid expressivist theories for moral predicates (...) to the case of aesthetic predicates. Hybrid expressivist theories make no explicit commitment about the kind of property expressed by the predicate, but make explicit commitments to implicated (or presupposed)expressive content. It is argued that dispositionalism about the properties expressed by aesthetic predicates, combined with expressive implicatures (or presuppositions), can account for aesthetic disagreements even in cases where subjects are not relevantly alike. (shrink)

Background Clinical ethics consultants are expected to “reduce disparities, discrimination, and inequities when providing consultations,” but few studies about inequities in ethics consultation exist.1 The objectives of this study were (1) to determine if there were racial or gender differences in the timing of requests for ethics consultations related to limiting treatment, and (2) if such differences were found, to identify factors associated with that difference and the role, if any, of ethics consultants in mitigating them. Methods The study was (...) a mixed methods retrospective study of consultation summaries and hospital and ethics center data on 56 age-and gender-matched Caucasian and African American Medicare patients who received ethics consultations related to issues around limiting medical treatment in the period 2011 to 2014. The average age of patients was 70.9. Results Consultation requests for females were made significantly earlier in their stays in the hospital (6.57 days) than were consultation requests made for males (16.07 days). For African American patients, the differences in admission-to-request intervals for female patients (5.93 days) and male patients (18.64 days) were greater than for Caucasian male and female patients. Differences in the timing of a consultation were not significantly correlated with the presence of an advance directive, the specialty of the attending physician, or the reasons for the consult request. Ethics consultants may have mitigated problems that developed during the lag in request times for African American males by spending more time, on average, on those consultations (316 minutes), especially more time, on average, than on consultations with Caucasian females (195 minutes). Most consultations (40 of 56) did result in movement toward limiting treatment, but no statistically significant differences were found among the groups studied in the movement toward limiting treatment. The average number of days from consult to discharge or death were strongly correlated with the intervals between admission to the hospital and request for an ethics consultation. Conclusion Our findings suggest race and gender disparities in the timing of ethics consultations that consultants may have partially mitigated. (shrink)

This article examines emergency ambulance calls made by lay callers for patients found to be in cardiac arrest when the paramedics arrived. Using conversation analysis, we explored the trajectories of calls in which the caller, before being asked by the call-taker, said why they were calling, that is, calls in which callers pre-empted a reason-for-the-call. Caller pre-emption can be disruptive when call-takers first need to obtain an address and telephone number. Pre-emptions have further implications when call-takers reach the stage when (...) they are required to deliver the scripted turn ‘tell me exactly what happened’. When there has been a pre-emption earlier on, callers tend to treat the scripted turn as a request for more information and may not repeat their reason-for-the-call. This can occasion delays and important information can be lost. We identified an effective alternative strategy used by some call-takers, pre-emption repeat, which callers treat as a request for confirmation. (shrink)