Ensuring adequate informed consent for surgery in a trauma setting is challenging. We developed and pilot tested an educational video containing information regarding the informed consent process for surgery in trauma patients and a knowledge measure instrument and evaluated whether the audiovisual presentation improved the patients’ knowledge regarding their procedure and aftercare and their satisfaction with the informed consent process. A modified Delphi technique in which a panel of experts participated in successive rounds of shared scoring of items to forecast (...) outcomes was applied to reach a consensus among the experts. The resulting consensus was used to develop the video content and questions for measuring the understanding of the informed consent for debridement surgery in limb trauma patients. The expert panel included experienced patients. The participants in this pilot study were enrolled as a convenience sample of adult trauma patients scheduled to receive surgery. The modified Delphi technique comprised three rounds over a 4-month period. The items given higher scores by the experts in several categories were chosen for the subsequent rounds until consensus was reached. The experts reached a consensus on each item after the three-round process. The final knowledge measure comprising 10 questions was developed and validated. Thirty eligible trauma patients presenting to the Emergency Department were approached and completed the questionnaires in this pilot study. The participants exhibited significantly higher mean knowledge and satisfaction scores after watching the educational video than before watching the video. Our process is promising for developing procedure-specific informed consent and audiovisual aids in medical and surgical specialties. The educational video was developed using a scientific method that integrated the opinions of different stakeholders, particularly patients. This video is a useful tool for improving the knowledge and satisfaction of trauma patients in the ED. The modified Delphi technique is an effective method for collecting experts’ opinions and reaching a consensus on the content of educational materials for informed consent. Institutions should prioritize patient-centered health care and develop a structured informed consent process to improve the quality of care. The ClinicalTrials.gov Identifier is NCT01338480. The date of registration was April 18, 2011. (shrink)

Background Ensuring adequate informed consent for surgery in a trauma setting is challenging. We developed and pilot tested an educational video containing information regarding the informed consent process for surgery in trauma patients and a knowledge measure instrument and evaluated whether the audiovisual presentation improved the patients’ knowledge regarding their procedure and aftercare and their satisfaction with the informed consent process. Methods A modified Delphi technique in which a panel of experts participated in successive rounds of shared scoring of items (...) to forecast outcomes was applied to reach a consensus among the experts. The resulting consensus was used to develop the video content and questions for measuring the understanding of the informed consent for debridement surgery in limb trauma patients. The expert panel included experienced patients. The participants in this pilot study were enrolled as a convenience sample of adult trauma patients scheduled to receive surgery. Results The modified Delphi technique comprised three rounds over a 4-month period. The items given higher scores by the experts in several categories were chosen for the subsequent rounds until consensus was reached. The experts reached a consensus on each item after the three-round process. The final knowledge measure comprising 10 questions was developed and validated. Thirty eligible trauma patients presenting to the Emergency Department were approached and completed the questionnaires in this pilot study. The participants exhibited significantly higher mean knowledge and satisfaction scores after watching the educational video than before watching the video. Conclusions Our process is promising for developing procedure-specific informed consent and audiovisual aids in medical and surgical specialties. The educational video was developed using a scientific method that integrated the opinions of different stakeholders, particularly patients. This video is a useful tool for improving the knowledge and satisfaction of trauma patients in the ED. The modified Delphi technique is an effective method for collecting experts’ opinions and reaching a consensus on the content of educational materials for informed consent. Institutions should prioritize patient-centered health care and develop a structured informed consent process to improve the quality of care. Trial registration The ClinicalTrials.gov Identifier is NCT01338480. The date of registration was April 18, 2011. (shrink)

We investigated whether, in the emergency department, educational video-assisted informed consent is superior to the conventional consent process, to inform trauma patients undergoing surgery about the procedure, benefits, risks, alternatives, and postoperative care. We conducted a prospective randomized controlled trial, with superiority study design. All trauma patients scheduled to receive trauma-related debridement surgery in the ED of Kaohsiung Medical University Hospital were included. Patients were assigned to one of two education protocols. Participants in the intervention group watched an educational video (...) illustrating informed consent information, whereas those in the control group read an informed consent document. The primary outcome was knowledge scores and the secondary outcome was assessment of patient satisfaction. A multivariable regression model, with predefined covariates, was used to analyze differences in knowledge scores and patient satisfaction levels between the groups. A total of 142 patients were enrolled, with 70 and 72 assigned to the intervention and control groups, respectively. Mean knowledge scores were higher in the intervention ) than in the control group. By multivariate analysis, the intervention group had significantly greater differences in knowledge scores. Age, injury severity score, and baseline knowledge score significantly affected the differences in knowledge scores. Significant improvements were observed in patients’ perception of statements addressing comprehension of the information provided, helpfulness of the supplied information for decision making, and satisfaction with the informed consent process. Multivariate analysis showed significant correlations between video education and patient satisfaction. Both the educational approach and severity of injury may have an impact on patient understanding during the informed consent process in an emergency environment. Video-assisted informed consent may improve the understanding of surgery and satisfaction with the informed consent process for trauma patients in the ED. Institutions should develop structured methods and other strategies to better inform trauma patients, facilitate treatment decisions, and improve patient satisfaction. The ClinicalTrials.gov Identifier is NCT01338480. The date of registration was April 18, 2011. (shrink)

Background: To evaluate the effectiveness of a multifaceted intervention in improving emergency department (ED) patient privacy and satisfaction in the crowded ED setting. Methods: A pre- and post-intervention study was conducted. A multifaceted intervention was implemented in a university-affiliated hospital ED. The intervention developed strategies to improve ED patient privacy and satisfaction, including redesigning the ED environment, process management, access control, and staff education and training, and encouraging ethics consultation. The effectiveness of the intervention was evaluated using patient surveys. Eligibility (...) data were collected after the intervention and compared to data collected before the intervention. Differences in patient satisfaction and patient perception of privacy were adjusted for predefined covariates using multivariable ordinal logistic regression. Results: Structured questionnaires were collected with 313 ED patients before the intervention and 341 ED patients after the intervention. There were no important covariate differences, except for treatment area, between the two groups. Significant improvements were observed in patient perception of "personal information overheard by others", being "seen by irrelevant persons", having "unintentionally heard inappropriate conversations from healthcare providers", and experiencing "providers' respect for my privacy". There was significant improvement in patient overall perception of privacy and satisfaction. There were statistically significant correlations between the intervention and patient overall perception of privacy and satisfaction on multivariable analysis. Conclusions: Significant improvements were achieved with an intervention. Patients perceived significantly more privacy and satisfaction in ED care after the intervention. We believe that these improvements were the result of major philosophical, administrative, and operational changes aimed at respecting both patient privacy and satisfaction. (shrink)

The meshed control theory assumes that cognitive control and automatic processes work together in the natural attention of experts for superior performance. However, the methods adopted by previous studies limit their capacity to provide in-depth information on the neuromotor processes. This experiment tested the theory with an alternative approach. Twelve skilled golfers were recruited to perform a putting task under three conditions: (1) normal condition, with no focus instruction (NC), (2) external focus of attention condition (EC), and (3) internal focus (...) of attention condition (IC). Four blocks of 10 putts each were performed under each condition. The putting success rate and accuracy were measured and electroencephalographies (EEGs) were recorded. The behavioral results showed that the NC produced a higher putting success rate and accuracy than the EC and IC. The EEG data showed that the skilled golfers’ attentional processes in the NC initially resembled those in the EC and then moved toward those in the IC just before putting. This indicates a switch from more automatic processes to cognitive control processes while preparing to putt. The findings offer support for the meshed control theory and indicate the dynamic nature of neuromotor processes for the superior performance of athletes in challenging situations. (shrink)

Do people with different views of what is fair attribute different intentions to actions? In a novel experimental design, participants were significantly more likely to attribute a no-redistribution vote to selfishness if they considered redistribution as being fair. I define this—attributing actions that do not adhere to one’s own fairness view to selfishness—as suspicious attribution. I develop a theory of intention attribution to show how suspicious attribution arises from two other findings from the experiment: the participants underestimate the number of (...) people with fairness views differing from their own and overestimate the selfishness of participants with other fairness views. I discuss how the findings can help explain political polarization. (shrink)

Selim Berker argues that epistemic consequentialism is pervasive in epistemology and that epistemic consequentialism is structurally flawed. is incorrect, however. I distinguish between epistemic consequentialism and epistemic instrumentalism and argue that most putative consequentialists should be considered instrumentalists. I also identify the structural problem of epistemic consequentialism Berker attempts to pinpoint and show that epistemic instrumentalism does not have the consequentialist problem.

To explain why we should be structurally rational – or mentally coherent – is notoriously difficult. Some philosophers argue that the normativity of structural rationality can be explained in terms of substantive rationality, which is a matter of correct response to reason. I argue that the psychological phenomena – positive illusions – are counterexamples to the substantivist approach. Substantivists dismiss the relevance of positive illusions because they accept evidentialism that reason for belief must be evidence. I argue that their evidentialist (...) stance would imply that we are caught in unsolvable dilemmas arising from positive illusions. (shrink)

The main purpose of this study was to validate a scale to examine the moral sensitivity of Korean nurses. A pre-existing scale, the Moral Sensitivity Questionnaire (MSQ), developed by Lützén, was used after deletion of three items. The reliability and validity of the scale were examined by using Cronbach’s alpha and factor analysis, respectively. According to the results, reliability of the scale was adequate but its construct validity was not fully supported. Through discussion on evidence of validity, five subconstructs emerged. (...) In particular, unlike the factor structure of the MSQ, two subconstructs, patient-oriented care and professional responsibility, were newly extracted. It was assumed that the other three MSQ subconstructs, conflict, meaning and benevolence (expressed as nurses being ethically good), would not be sensitive to cultural background. Given these findings, interpretations about the meaning of moral sensitivity of Korean nurses are discussed. (shrink)

Virtue epistemology maintains that epistemic normativity is a kind of performance normativity, according to which evaluating a belief is like evaluating a sport or musical performance. I examine this thesis through the objection that a belief cannot be evaluated as a performance because it is not a performance but a state. I argue that virtue epistemology can be defended on the grounds that we often evaluate a performance through evaluating the result of the performance. The upshot of my account is (...) that when a belief is evaluated under performance normativity, what we evaluate is not belief, but cognitive performance. My account of virtue epistemology offers a simple explanation of why knowledge is more valuable than true belief. (shrink)

A popular evidentialist argument against pragmatism is based on reason internalism: the view that a normative reason for one to φ must be able to guide one in normative deliberation whether to φ. In the case of belief, this argument maintains that, when deliberating whether to believe p, one must deliberate whether p is true. Since pragmatic considerations cannot weigh in our deliberation whether p, the argument concludes that pragmatism is false. I argue that evidentialists fail to recognize that the (...) question whether to φ is essentially the question whether one should φ. Furthermore, the question of whether one should believe p can be answered on pragmatic grounds. The internalist argument turns out to favor pragmatism. (shrink)

Virtue epistemology argues that knowledge is more valuable than Gettierized belief because knowledge is an achievement, but Gettierized belief is not. The key premise in the achievement argument is that achievement is apt (successful because competent) and Gettierized belief is inapt (successful because lucky). I first argue that the intuition behind the achievement argument is based wrongly on the fact that ‘being successful because lucky’ implicates ‘being not competent enough’. I then offer an argument from moral luck to argue that (...) virtue epistemologists should maintain that knowledge is no more valuable than Gettierized belief. (shrink)

This study analyses the types and frequencies of ethical dilemmas and the rationale of ethical decision making in student nurses; it also evaluates their decision making. One hundred senior student nurses who were enrolled in a two-credit course in nursing ethics were asked to provide an informal description of a dilemma that they had experienced during their clinical practice. The results were as follows. The ethical dilemmas identified fell into four categories and were of 27 types. Those most frequently experienced (...) were ‘family giving up on a patient because he or she could not be cured’, and ‘not telling the truth to the patient’. The Korean Nurses’ Code of Ethics was applied, in particular the preamble, and the third, fourth, seventh and tenth clauses. The most common rule of ethics and principle applied in these nurses’ ethical decision making were veracity and nonmaleficence. With regard to the moral reasoning process, the primary concern was the welfare of the patients. These students were equipped with the ability to exercise critical and reflective thought when they experienced ethical dilemmas. (shrink)

Drawing upon Hannah Arendt's and Carl Schmitt's theories on the relationship between nomos and boundary, this paper revisits how constitutionalism and political power are reconciled as constitutional ordering. It first analyzes constitutionalism in the light of political modernity. Indicating that political power grounded by constitutions is omnipotent, complementing and completing constitutionalism, the paper contends that an omnipotent constitutional ordering is anything but an unleashed Leviathan. It is argued that constitutional omnipotence is framed and thus constrained by a constitutional nomos, the (...) matrix of which is a dual delimitation of boundaries, generational, and jurisdictional. (shrink)

如果機器人的發展要能如科幻想像一般，在沒有人類監督下自動地工作，就必須確定機器人不會做出道德上錯誤的行為。 根據行為主義式的道德主體觀，若就外顯行為來看，機器人在道德上的表現跟人類一般，機器人就可被視為道德主體。從這很自然地引伸出機器人的道德擬人主義：凡適用於人類的道德規則就適用於機器人。我反對道德擬人主義 ，藉由史特勞森對於人際關係與反應態度的洞見，並以家長主義行為為例，我論述由於機器人缺乏人格性，無法參與人際關係，因此在關於家長主義行為上，機器人應該比人類受到更嚴格的限制。.

"The articles in this volume present an important selection of Jao Tsung-i's research in the field of the early Chinese intellectual tradition, especially as concerns the question of the conditio humana. Whether his focus is on myth, religion, philosophy or morals, Jao constantly aims at describing the Chinese version of a series of developments that are broadly associated with the Axial Age in the study of the ancient world in general. He is particularly interested in showing how early China (...) had developed its own notion of transcendence as well as a system of prediction and morals that allowed man to act on his own account, without having to rely on divine providence"--. (shrink)

Purpose: The purpose of this study was to verify the long-term effect of adverse childhood experiences, school disengagement, and the reasons for leaving school on adolescent delinquency while adjusting for sex.Methods: Data were collected from 663 teenagers [male 368, female 295; mean age = 16.81 ; age range = 13–19 years] through a Longitudinal Survey and Support Plan for Dropouts.Results: Multivariate latent growth modeling demonstrated that ACEs and school disengagement are positively associated with delinquency and the mediating effect of school (...) disengagement on association between ACEs and delinquency was verified. Teenagers who quit school for personal reasons reported fewer instances of delinquent behavior than adolescents who left because of school reasons.Conclusion: This study suggests that researchers and teachers need to consider ACEs and school disengagement as a warning index for delinquency with school dropout. In addition, the reason for leaving school should be considered to clarify the effect of school dropout on delinquency in adolescents who dropout. (shrink)