The paper deals with the problem of future biology teachers’ vocational preparation process and shaping in them of those capacities that contribute to the conservation and enhancement of our planet’s biodiversity as a reflection of the leading sustainable development goals of society. Such personality traits are viewed through the prism of forming the future biology teachers’ professional and terminological competence. The main aspects and categories that characterize the professional and terminological competence of future biology teachers, including terminology, nomenclature, term, (...) nomen and term element, have been explained. The criteria and stages of shaping the future biology teachers’ professional and terminological competence during the vocational training process have been fixed. Methods, techniques, technologies, guiding principles and forms of staged work on the forming of an active terminological dictionary of students have been described and specified. The content of the distant special course “Latin. Botanical Terminology”, which provides training for future teachers to study the professional subjects and to understand of international scientific terminology, has been presented. It is concluded that the proper level of formation of the future biology teachers’ professional and terminological competence will eventually ensure the qualitative preparation of pupils for life in a sustainable development era. (shrink)

The arrival of refugee pupils in UK schools has presented significant challenges to staff, pupils and families. The aim of this study was to record and analyse the views of teaching staff regarding their experiences of integrating these pupils into schools in Newcastle upon Tyne. A questionnaire was sent to 53 schools in the city known to have pupils who are refugees or asylum seekers. Questions focused on key issues identified by the Local Education Authority Working (...) Group for Refugees and Asylum Seekers, including the dissemination of information prior to the arrival of new pupils, staff training and the response of the school community as a whole. Twenty?four questionnaires were completed (response rate 45.3%), from two nurseries, 13 primary schools, seven secondary schools and one special school. The overwhelming need identified was for improved access to interpreting services, and more reliable information about pupils? backgrounds. It was evident that integration is approached differently by individual schools depending on their overall ethnic mix and the availability of resources and support networks. (shrink)

As the use of automated social media analysis tools surges, concerns over accuracy of analytics have increased. Some tentative evidence suggests that sarcasm alone could account for as much as a 50% drop in accuracy when automatically detecting sentiment. This paper assesses and outlines the prevalence of sarcastic and ironic language within social media posts. Several past studies proposed models for automatic sarcasm and irony detection for sentiment analysis; however, these approaches result in models trained on training data of highly (...) questionable quality, with little qualitative appreciation of the underlying data. To understand the issues and scale of the problem, we are the first to conduct and present results of a focused manual semantic annotation analysis of two datasets of Twitter messages, associated with; hashtags commonly employed in automated sarcasm and irony detection approaches, and tweets relating to 25 distinct events, including, scandals, product releases, cultural events, accidents, terror incidents, etc. We also highlight the contextualised use of multi-word hashtags in the communication of humour, sarcasm and irony, pointing out that many sentiment analysis tools simply fail to recognise such hashtag-based expressions. Our findings also offer indicative evidence regarding the quality of training data used for automated machine learning models in sarcasm, irony and sentiment detection. Worryingly only 15% of tweets labelled as sarcastic were truly sarcastic. We highlight the need for future research studies to rethink their approach to data preparation and a more careful interpretation of sentiment analysis. (shrink)

This paper reports the findings of a predominantly qualitative study that explored the effects of the practice of Philosophy for Children on pupils’ affective engagement.[1] From its conception, the practice of P4C has been linked to the development of caring and collaborative thinking and the study aimed to closely consider that relationship. An appropriate self-designed P4C program was implemented with 75 Year 9 pupils of Religious Education at an independent secondary school in the United Kingdom. An interpretive (...) research approach was taken and thematic analysis was appropriated to analyse the data. Findings supported the claims of previous research that P4C can foster affective engagement in many pupils, particularly those pupils who find emotional expression and interpersonal interactions challenging. A tentative conclusion reached supposes that P4C has the potential to contribute to the affective engagement of pupils, but with the recommendation that implementing a P4C program must be executed carefully and with the mindfulness that it may not have the same potential or usefulness for all pupils universally. (shrink)

One of the main priorities of current educational systems is a strong connection between education provided by schools and the requirements of a successful integration in the social life and work field. This article offers the teachers’ perspective on the various ways in which outdoor learning can be useful in creating teaching-learning situations that prepare pupils to be active citizens and to have smoother integration in the social life and this way, on the labor market. The findings of a (...) brief study among teachers from Arad County is presented. The method that was used is the survey based on a questionnaire. The main instrument that used was the questionnaire, which was based on a number of 12 variables. The quantitative data obtained was processed in the SPSS statistical program. The preliminary results show that even if teachers have some knowledge on the benefits of outdoor education regarding future involvement of pupils in social life, they tend to rarely use it in their educational practice. This happens because of the lack of correct and valid information they have on this type of education, and also because of the misconceptions of parents, who refuse to cooperate regarding this issue. The present study brings and important contribution in this research field, highlighting the values of outdoor education, both theoretically and practically. (shrink)

The competency profile underlying higher nursing education in the Netherlands states that bachelor-prepared nurses are expected to be able to participate in ethics committees. What knowledge, skills and attitudes are involved in this participation is unclear. In five consecutive years, groups of two to three fourth-year (bachelor) nursing students conducted 8 to 11 semi-structured interviews each with nurses in ethics committees. The question was what competencies these nurses themselves say they need to participate in such committees. This article reports the (...) aggregate of the 52 interviews in these five studies. Regarding knowledge, the article reports on health law, ethics and professional knowledge. Regarding skills, communication is mentioned, as are professional skills and skills for ‘doing ethics’. An open and respectful attitude towards patients and fellow committee members is required, as well as commitment to patient care, committee work and professional ethics. The right attitude for a nurse in an ethics committee is said to include a reflective and perceptive attitude, along with an awareness of one’s own limitations and convictions. A detailed competency profile for nurses’ participation in ethics committees as outlined in the recommendations may serve nursing education, institutional committees and nurses themselves to meet the demands of nurses’ preparation for clinical ethics consultations. (shrink)

The scarcity of resources during the COVID‐19 pandemic caused ethical dilemmas in prioritizing patients for treatment. Medical and ethical guidance only emphasizes clinical procedures but does not consider the sociocultural aspect. This study explored the perception of former COVID‐19 patients and their families on the decision‐making process of the patient's selection at a time of scarcity of resources. The result will inform the development of an ethical guide for allocating scarce resources that aligns with Indonesian culture. We conducted qualitative (...) research with in‐depth interviews between May ‐ December 2022 involving sixteen participants from various cities in Indonesia. We transcribed the interviews and analyzed the results using thematic analysis. This study found that doctor's decisions often differed from patient's expectations in allocating scarce resources, and therefore, it should be communicated appropriately. Medical decisions were not sufficiently made ethically, but must also be made communicatively. In Indonesia's strong communal culture, community involvement was essential to distributing limited resources. A better approach to ethical education, including adequate communication skills, is necessary to prepare health professionals for facing unpredictable future pandemics. (shrink)

Objectives: To explore opinions and attitudes regarding the current information-giving practices in research involving adults with intellectual disabilities.Design: Qualitative focus group study with a purposive sample.Setting: An intellectual disabilities service within the NHSParticipants: A sample of 26 individuals including adults with mild intellectual disability, carers, clinicians, care managers and the charitable sector.Results: Three main themes were identified: process, format, and content. There was agreement that there is a need for improvement in the process and quality of information giving. With (...) regard to the content of information, there was little discrepancy between the study findings and existing guidance.Conclusions: Information should be presented in different formats and prepared with input from appropriate professions. Additionally the roles of peers, carers and other professionals in the process of information giving should be considered. (shrink)

The current qualitative study investigated prevalence and types of academic integrity violations in psychology graduate students and solicited student recommendations for how academic institutions, professors, and peers may act to discourage or prevent its occurrence. Students were recruited through email lists and asked to participate in an online study with a series of open-ended questions assessing integrity violations and prevention recommendations. Results revealed academic integrity violations were relatively infrequent and most were of relatively low severity. Common antecedents to integrity (...) violations included inadequate preparation, task difficulty, and external stressors such as health ailments that interfered with preparation. Most violators reported engaging in a rational decision making process, weighing the pros and cons of cheating, and most did not reveal the violation to anyone. The majority of violations resulted in no negative consequences to the student and 44 % reported they would do it again. Students recommended better dissemination of integrity policies, greater oversight of graduate students, harsher punishments for violations, and consistent reporting of violations as prevention strategies. Results highlight how academic dishonesty in psychology graduate students may be a product of multiple time and resource demands, coupled with low self-efficacy to meet or negotiate these demands. Despite reports of external pressures being the top reason for academic integrity violations, few recommendations focused on decreasing external pressures as a mechanism to curb cheating. (shrink)

Examining the nature of teachers’ emotions and how they are managed and regulated in the act of teaching is crucial to assess the quality of teacher’s instructions. Despite the essential role emotions play in teachers’ lives and instruction, research on teachers’ emotions has not paid much attention on teachers’ state emotions in the context of daily teaching. Significant portion of literature has described teachers’ emotions by foregrounding trait emotions through deductive methodological approaches. This paper explored elementary teachers’ state and trait (...) emotions while preparing for teaching and during teaching, reasons that underlie these emotions, and the relationship between their emotions and the quality of their mathematics instruction. Participants were seven elementary teachers working in the U.S. who participated in Holistic Individualized Coaching (HIC) professional development that consisted of 5 cycles of coaching over an year. For each coaching cycle pre-coaching conversation and post-coaching conversation data were collected regarding state emotions teachers felt in anticipation of teaching and during teaching retrospectively. Also, teachers responded adapted Teaching Emotion Scale (TES) that was aimed to measure trait emotions. In order to compare teachers’ emotions with instructional quality, coaching session were video recorded and analyzed to determine the quality of instruction. Findings of this study showed that teachers reported 6 categories of emotions (positive, negative, neutral, mixed-positive, mixed-negative, and mixed-complex), and often in non-typical ways (e.g., “not nervous”, “anxious but in a positive way”), and mixed emotions were the most dominant category. Also, teachers had more positive emotions anticipating teaching, than actually teaching the lesson, and there was no noticeable change of emotions across the 5 coaching cycles. The reason teachers felt mixed emotions reflected complex and context-specific nature of teaching, which was not articulated in the literature. There were no clear relationships between emotional experiences and instructional quality. This study allowed participants to freely describe their authentic, complex, overlapping, and ambiguous emotions in the context of active teaching, which contributes opening up the possibilities of diversifying teacher emotion research and shows the significance and usefulness of understanding teachers’ state emotions. (shrink)

BackgroundThe advent of learning healthcare systems (LHSs) raises an important implementation challenge concerning how to request and manage consent to support secondary use of data in learning cycles, particularly research activities. Current consent models in Quebec were not established with the context of LHSs in mind and do not support the agility and transparency required to obtain consent from all involved, especially the citizens. Therefore, a new approach to consent is needed. Previous work identified the meta-consent model as a promising (...) alternative to fulfill the requirements of LHSs, particularly large-scale deployments. We elicited the public’s attitude toward the meta-consent model to evaluate if the model could be understood by the citizens and would be deemed acceptable to prepare for its possible implementation in Quebec.MethodsEight focus groups, with a total of 63 members of the general public from various backgrounds were conducted in Quebec, Canada, in 2019. Explicit attention was given to literacy levels, language spoken at home and rural vs urban settings. We assessed attitudes, concerns and facilitators regarding key components of the meta-consent model: predefined categories to personalized consent requests, a dynamic web-based infrastructure to record meta-consent, and default settings. To analyse the discussions, a thematic content analysis was performed using a qualitative software.ResultsOur findings showed that participants were supportive of this new approach of consent as it promotes transparency and offers autonomy for the management of their health data. Key facilitators were identified to be considered in the implementation of a meta-consent model in the Quebec LHSs: information and transparency, awareness campaigns, development of educational tools, collaboration of front-line healthcare professionals, default settings deemed acceptable by the society as well as close partnerships with recognized and trusted institutions.ConclusionsThis qualitative study reveals the openness of a sample of the Quebec population regarding the meta-consent model for secondary use of health data for research. This first exploratory study conducted with the public is an important step in guiding decision-makers in the next phases of implementing the various strategies to support access and use of health data in Quebec. (shrink)

Background: The COVID-19 pandemic severely strained the already unprepared Italian healthcare system. This had repercussions on healthcare workers, stemming, in particular, from a lack of clear guidelines, adequate protective equipment, and professional preparedness. Such conditions were especially prevalent in Northern Italy.Objectives: This study aimed to examine COVID-19-related professional and psychoemotional stress among nurses and doctors in two hospitals in Northern Italy, along with the worst critical incidents affecting healthcare personnel. A parallel objective was to elicit healthcare professionals' opinions about what (...) changes are needed in the healthcare system's operations, as well as about the relational/emotional skills that are needed to better manage relationships with patients in emergency situations.Participants: Snowball sampling was used to recruit participants and yielded 17 hospital professionals: six nurses and 11 doctors. Three of these professionals worked in intensive care and the others in different wards. All had close contact with COVID-19 patients.Methods: The study employed a qualitative research design, using in-depth interviews of ~60 min each that were conducted via Skype video calls. The interviews were recorded and transcribed, then analysed. The qualitative analysis employed mixed methods to identify the most relevant and recursive themes from the interviews.Results: Four fundamental themes emerged from our analysis of the interview texts: disorganisation and psychoemotional stress; urgency and critical incidents; everything surreal; and disruptions in empathetic relationships with patients.Conclusions: Through our analysis of the interview narratives, we found that systematic and in-depth psychological training is needed to prepare professionals for altered relationships with patients in emergencies; use of exceptional medical equipment; elaboration of new bioethical models suitable for disasters and pandemics; and engagement with the themes of death and dying. (shrink)

This international ensemble of scholars discuss Thomas Nail’s The Figure of the Migrant. These scholars represent various disciplines within the academy and divergent methodologies. One thing we share in common, though, is the opinion that the migrant needs to occupy a more significant place within our political theory and policy. Nail’s book is one of kinopolitics, that is, a politics of movement. It provides a kind of theory of social motion. According to Nail, the book offers a remedy to problems (...) in how the migrant is typically theorized, namely that the migrant is understood as a derivative figure in contrast to the stable denizen and the migrant is discussed through the lens of the state. His remedial maneuver mobilizes the potential to understand the figure of the migrant by placing the migrant in the primary position, by offering a political philosophy of the migrant. (shrink)

Background: Doping has been a prominent issue for the sport of athletics in recent years. The endurance disciplines, which currently account for 56% of the global anti-doping rule violations in athletics, appear to be particularly high risk for doping.Objective: Using this high-risk, high-pressure context, the main purpose of this study was to investigate the human impact of doping and anti-doping on “clean” athletes. The secondary aim of the study was to better understand the reasons for, and barriers to, competing “clean” (...) among this group of athletes.Method: Semi-structured interviews were conducted with 11 elite distance runners from the UK to explore: the reasons and motivations for competing clean. Perceptions of the anti-doping system, and experiences of being part of that system. Views on the prevalence and causes of doping and the impact of doping on the lives of clean athletes. The interviews were audio-recorded, transcribed verbatim, and analysed using Reflexive Thematic Analysis.Results: Four major themes were identified: The participants in this study have not been tempted to use prohibited substances or methods; they compete in their sport for the personal satisfaction of seeing how good they can be, rather than in pursuit of winning at all costs. Anti-doping does not currently prevent doping effectively and is not implemented evenly across the globe. Doping was perceived as a major issue and was felt to be borne out of certain sporting cultures in which doping is enabled. Doping has impacted the careers of clean athletes in irreversible ways and presents a continuing challenge to the psychological preparation for competition.Conclusions: Clean athletes suffer negative consequences from both doping and anti-doping. ADOs must collaborate across borders to ensure a more even implementation of anti-doping activities, to facilitate a more level playing field on the global stage. ADOs must also acknowledge the existence of a large group of athletes who would never consider deliberately doping and make anti-doping work for these athletes too. (shrink)

BackgroundThe pharmaceutical market in Bangladesh is highly concentrated. Due to high competition aggressive marketing strategies are adopted for greater market share, which sometimes cross limit. There is lack of data on this aspect in Bangladesh. This exploratory study aimed to fill this gap by investigating current promotional practices of the pharmaceutical companies including the role of their medical representatives.MethodsThis qualitative study was conducted as part of a larger study to explore the status of governance in health sector in 2009. (...) Data were collected from Dhaka, Chittagong and Bogra districts through in-depth interview, observation, and round table discussion.ResultsFindings reveal a highly structured system geared to generate prescriptions and ensure market share instituted by the pharmaceuticals. A comprehensive training curriculum for the MRs prepares the newly recruited science graduates for generating enough prescriptions by catering to the identified needs and demands of the physicians expressed or otherwise, and thus grab higher market-share for the companies they represent. Approaches such as inducements, persuasion, emotional blackmail, serving family members, etc. are used. The type, quantity and quality of inducements offered to the physicians depend upon his/her capacity to produce prescriptions. The popular physicians are cultivated meticulously by the MRs to establish brand loyalty and fulfill individual and company targets. The physicians, willingly or unwillingly, become part of the system with few exceptions. Neither the regulatory authority nor the professional or consumer rights bodies has any role to control or ractify the process.ConclusionsThe aggressive marketing of the pharmaceutical companies compel their MRs, programmed to maximize market share, to adopt unethical means if and when necessary. When medicines are prescribed and dispensed more for financial interests than for needs of the patients, it reflects system’s failed ability to hold individuals and entities accountable for adhering to basic professional ethics, code of conduct, and statutory laws. (shrink)

In this study, information about inductive and deductive methods and the differences between these methods was given. Afterwards, grammar teaching in Turkey was evaluated in terms of method. Then, the grammar teaching methods of the Arabic grammar books called al-Naḥwu'l-Wâḍıḥ and al-Qawâʻid al-ʻArabiyya al-Muyassara, which were prepared by following the inductive method, were examined under the headings of preface, handling of the subjects and exercises. In the continuation of the study a qualitative research was conducted using the semi-structured interview (...) technique with 16 randomly selected students, 8 of whom who have been studying Arabic for a long time and 8 of whom have started their Arabic education at university in order to learn the approaches of the students to the grammar teaching methods who took the course which the work called al-Qavâʻid al-ʻArabiyya al-Muyassara was used as a source book in the 2020-2021 academic year, in the first year of the Department of Arabic Language and Literature at Selcuk University in addition to a lesson which the grammar book prepared with the deductive method. While it was seen that the majority of the students in both groups participated in the interview preferred the deductive method, it was understood that the students had different approaches with their method preferences in terms of explaining the grammar issue in detail and giving more space to terms. In the study, it was concluded that it would be more beneficial to follow a mixed method in which the the positive aspects are considered, since it was seen that there were aspects that both educators and students found positive and negative in both methods. (shrink)

It is often assumed that the reaction time of a saccade toward visual and/or auditory stimuli reflects the sensitivities of our oculomotor-orienting system to stimulus saliency. Endogenous factors, as well as stimulus-related factors, would also affect the saccadic reaction time. However, it was not clear how these factors interact and to what extent visual and auditory-targeting saccades are accounted for by common mechanisms. The present study examined the effect of, and the interaction between, stimulus saliency and audiovisual spatial congruency on (...) the SRT for visual- and for auditory-target conditions. We also analyzed pre-target pupil size to examine the relationship between saccade preparation and pupil size. Pupil size is considered to reflect arousal states coupling with locus-coeruleus activity during a cognitive task. The main findings were that the pattern of the examined effects on the SRT varied between visual- and auditory-auditory target conditions, the effect of stimulus saliency was significant for the visual-target condition, but not significant for the auditory-target condition, Pupil velocity, not absolute pupil size, was sensitive to task set, and there was a significant correlation between the pre-saccade absolute pupil size and the SRTs for the visual-target condition but not for the auditory-target condition. The discrepancy between target modalities for the effect of pupil velocity and between the absolute pupil size and pupil velocity for the correlation with SRT may imply that the pupil effect for the visual-target condition was caused by a modality-specific link between pupil size modulation and the SC rather than by the LC-NE system. These results support the idea that different threshold mechanisms in the SC may be involved in the initiation of saccades toward visual and auditory targets. (shrink)

The educational reform movement in social studies has focused on constructivist and inquiry-oriented approaches to the teaching of history. Since many social studies teacher education students have had little experience with such approaches in their own schooling, special attention needs to be given to these topics within teacher preparation programs if they are to be implemented in schools. One pathway for accomplishing this is through investigations of local history. This article presents an exploratory qualitative research study investigating pre-service (...) teachers' understanding of inquiry and the impact of a set of lessons in a methods class using local history in the service of inquiry-oriented learning. The results suggest that local history can be an effective tool for stimulating interest in and a deeper understanding of inquiry-oriented teaching. (shrink)

Progress in artificial intelligence technological innovation raises questions about the role of medical staff and the meaning of medical specialization. This study involved a qualitative survey of medical professionals and ordinary citizens to expand knowledge of this topic. A combination of Neo-Socratic Dialogue and Transfer Dialogue techniques, was used to acquire knowledge related to emerging forms of medical care and changing work demands after the implementation of AI, qualitatively analyzing the TD transcript only. Eleven subjects participated in two surveys. (...) The main points raised during TD were classified into five categories: i) Functions which AI could perform/would find difficult to perform, ii) Changes in medicine caused by AI, iii) Necessary preparations for the application of AI to medicine, iv) Concerns about AI, and v) Others. The survey findings suggest that initiatives to promote the acceptance of each individual in society and appropriate technological development are essential to the process of preparing for the changes in medicine following the implementation of AI. These preparatory conditions cannot be limited to medical professionals, and must extend to workers across all disciplines and to society as a whole. (shrink)

Previous studies have shown that the use of motivational regulation strategies has the potential to sustain invested effort and persistence in the learning process. Combining different methods (questionnaires and standardized diaries), the present study aimed to determine the role of motivational regulation in an exam preparation period. Motivational regulation is differentiated in a quantitative (extent of strategy use) and a qualitative (planning, implementing, monitoring and correcting strategy use) aspect. One hundred and fifteen university students reported the quantity and (...) quality of their motivational regulation strategy use in a pretest and kept a standardized learning diary focused on motivational difficulties and invested effort over a 14-day period just before an exam in their studies. Exam performance was assessed afterwards. Results revealed positive effects of both aspects of motivational regulation on invested effort in exam preparation and exam performance. Moreover, a high quality of motivational regulation was associated with reduced negative effects of motivational difficulties on invested effort during studying—implying that motivational regulation can buffer against specific motivational problems occurring in the learning process. (shrink)

Introduction The major burden of the COVID-19 pandemic has been mainly on healthcare workers (HCWs) and as a result many of them have been afflicted with the disease thus far. -/- Purpose The present study was an effort to investigate Tehran University of Medical Sciences HCWs' experiences of COVID-19 during the pandemic in Tehran, Iran. -/- Methods This study is essentially a conventional qualitative content analysis. Twenty-six HCWs (including 7 physicians, 16 nurses, and 3 physiotherapists) were purposefully selected to (...) participate in the study. The data were collected from April 2020 to January 2021 through semi-structured face-to-face interviews. The interviews were transcribed and then analyzed based on the Graneheim and Lundman method using MAXQDA 12. -/- Results Based on the qualitative content analysis which resulted in 364 initial codes, three themes and eight subthemes were extracted. The extracted themes were “support,” “control,” and “improvement.” -/- Conclusions HCWs are in close contact with COVID-19 patients as part of their professional careers and the provision of quality patient care in times of crises is unattainable unless HCWs enjoy support and their own health is maintained. Making institutional, national, and international preparations for their protection is an obligation. (shrink)

Genetic results are usually not returned to research participants in Uganda despite their increased demand. We report on researchers’ perceptions and experiences of return of individual genetic research results. The study involved 15 in-depth interviews of investigators involved in genetics and/or genomic research. A thematic approach was used to interpret the results. The four themes that emerged from the data were the need for return of individual results including incidental findings, community engagement and the consenting process, implications and challenges to (...) return of individual results. While researchers are willing to return clinically significant genetic results to research participants, they remain unsure of how this should be implemented. Suggestions to aid implementation of return of results included reconsenting of participants before receiving individual genetic results and increasing access to genetic counseling services. Community engagement to determine community perceptions and individual preferences for the return of results, and also prepare participants to safely receive results emerged as another way to support return of results. Researchers have a positive attitude toward the return of clinically significant genetic results to research participants. There is need to develop national guidance on genetic research and also build capacity for clinical genetics and genetic counseling. (shrink)

Clinical ethics committees have existed in Norway since 1996. By now all hospital trusts have one. An evaluation of these committees’ work was started in 2004. This paper presents results from an interview study of eight clinicians who evaluated six committees’ deliberations on 10 clinical cases. The study indicates that the clinicians found the clinical ethics consultations useful and worth while doing. However, a systematic approach to case consultations is vital. Procedures and mandate of the committees should be known to (...) clinicians in advance to ensure that they know what to expect. Equally important is bringing all relevant facts, medical as well as psychosocial, into the discussion. A written report from the deliberation is also important for the committees to be taken seriously by the clinicians. This study indicates that the clinicians want to be included in the deliberation, and not only in the preparation or follow-up. Obstacles for referring a case to the committee are the medical culture’s conflict aversion and its anxiety of being judged by outsiders. The committees were described as a court by some of the clinicians. This is a challenge for the committees in their attempt to balance support and critique in their consultation services. (shrink)

In the Australian state of Victoria, legislation allowing voluntary assisted dying (VAD) passed through parliament in November 2017. There was then an eighteen-month period before the start date for patient access to VAD, referred to as the “implementation period.” The implementation period was intended to allow time for the relevant government department and affected organizations to develop processes before the Act came into effect in June 2019. This qualitative interview study investigates the perspectives of a multidisciplinary sample of twelve (...) clinicians from a single metropolitan hospital during this implementation period. Maximum variation sampling was utilized to ensure breadth across discipline (medical, nursing, allied health), speciality, and stated level of support for the VAD legislation. Four key themes were identified from the interview data: preparing for the unknown, ethical diversity within the organization, building a respectful culture, and concerns about the inability of the legislated approach to capture clinical nuances. Overall, these clinicians’ workplace experiences during the implementation period were shaped by the ethical diversity within their organization and a sense of uncertainty about how the VAD legislation would integrate with the practical realities of their clinical setting. The concept of “ethical diversity” could be a useful one for supporting staff in an organization during a VAD implementation period. (shrink)

This qualitative cross-sectional survey, undertaken in the antenatal booking clinics of a hospital in central London, explores pregnant women’s responses to routine HIV testing, examines their reasons for declining or accepting the test, and assesses how far their responses fulfil standard criteria for informed consent. Of the 32 women interviewed, only 10 participants were prepared for HIV testing at their booking interview. None of the women viewed themselves as being particularly at risk for HIV infection. The minority of the (...) participants who declined testing differed from those who accepted, by interpreting test acceptance as risky behaviour, privileging the negative outcomes of HIV positivity and expressing an inability to cope with these, should they occur. Troublingly, only a minority of women had a broad understanding of the rationale for the test, and none fulfilled the standard criteria for informed consent. This study suggests that, although routine screening combined with professional recommendation may be successful in increasing uptake, this may be at the cost of eroding informed consent. Protecting third parties from a preventable disease may outweigh the moral duty of respecting autonomy, enshrined in Western bioethical tradition. Nevertheless, such a policy should be made transparent, debated in the public domain and negotiated with women seeking antenatal care. (shrink)

Research about the Olympic Games has primarily focused on preparing athletes for competition. Less attention has been paid to the post-Olympic-phase and athlete well-being during this time. This study explored Australian Olympic athletes’ experiences following the conclusion of the 2016 Rio Olympic Games, including the factors that may have contributed to or challenged their well-being during this time. Eighteen athletes participated in semi-structured interviews and thematic analysis revealed that when Olympic performance appraisal met prior expectations, when athletes planned for a (...) return to work or study, and when support from a variety of sources was readily available, this positively influenced athletes’ well-being during the POP. When these factors were not in place, more challenging post-Games experiences were present, and well-being was compromised. The findings contribute to the broader literature on elite athlete well-being and at an applied level, may be used to inform targeted programs that focus on supporting athletes after an Olympic campaign. (shrink)

This case study examines a teaching candidate's completion of a major assessment project, including his approach to lesson planning and assessment design, the creation of rubrics, and the crafting of narratives to analyze his students’ work. Qualitative data analysis suggests that this beginning teacher, who excelled in planning and teaching for historical thinking, needed additional support in honing his skills with respect to discipline-based assessment. In his analysis of students’ work and his reflection on the assessments, the teaching candidate (...) retreated to generalist stances that made no references to thinking historically. The teaching candidate demonstrated an ability to design discipline-based assessments and an inability to use a discipline-based framework to assess and describe his students’ work. (shrink)

BackgroundAll hospital trusts in Norway have clinical ethics committees. Some of them invite next of kin/patients to be present during the discussion of their case. This study looks closer at how parents of seriously ill children have experienced being involved in CEC discussions.MethodsTen next of kin of six seriously ill children were interviewed. Their cases were discussed in two CECs between April of 2011 and March of 2014. The main ethical dilemma was limitation of life-prolonging treatment. Health care personnel who (...) could elucidate the case were also present in the discussion. The interviewer observed each discussion and then interviewed the next of kin shortly after the meeting, following a structured interview guide.ResultsAll next of kin emphasized that it had been important for them to be present. They stressed the important role of the CEC chair and appreciated that their case was discussed in a systematic way. Some next of kin appreciated that the child’s impending death was discussed openly, and believed that this would facilitate their future grieving. Having had an opportunity to hear all the arguments behind the decision to be made would probably help them to accept the road ahead.All of them felt that they were taken seriously and listened to. They felt that they had added vital information to the discussion. All but one couple did not want any decision-making responsibility, some of them even worried that they might have influenced the discussion too much.ConclusionsNone of the next of kin felt that being present during the CEC discussion had been too heavy a burden. On the contrary, they claimed that their presence in a CEC discussion may add vital information to the discussion and may improve the quality of the decision. It is important that the CEC’s role is explained to them so they are well prepared for what to expect. They need to be followed up after the discussion. (shrink)

RESUMEN Introducción: No todos los especialistas en formación en Anestesiología y Reanimación revelan una actuación eficiente en la atención al paciente en shock. Objetivo: Exponer elementos relacionados con un sistema de talleres docentes para potenciar la preparación del especialista en formación en Anestesiología para la atención médica integral al paciente en shock. Material y método: Se realizó un estudio prospectivo con enfoque cualitativo que tiene en cuenta la sistematización de los referentes teóricos esenciales que posibilitan la satisfacción del objetivo declarado. (...) Resultados: se definió operacionalmente la categoría preparación del especialista en formación en Anestesiología y Reanimación para la atención médica integral al paciente en shock, y se diseñó un sistema de talleres docentes que puede guiar el trabajo metodológico del colectivo de profesores para la consecución de este propósito. Discusión: Se propuso una modelación didáctica del proceso de preparación de este especialista en formación, que puede tributar a una transformación cualitativamente superior del proceso de formación, y a la profesionalización pedagógica del docente. ABSTRACT Introduction: Not all the specialists in formation in Anesthesiology and Revival reveal an efficient performance in the attention to the patient in shock. Objective: To exhibit elements related to a system of teaching workshops to promote the preparation of the specialist in formation in Anesthesiology for the integral medical attention to the patient in shock. Material and method: A pilot study was carried out with qualitative approach that bears in mind the systematization of the essential theoretical basis that make possible the satisfaction of the declared objective. Results: it was defined operationally the category preparation of the specialist in formation in Anesthesiology and Revival for the integral medical attention to the patient in shock, and it was designed a system of teaching workshops that can guide the methodological work of the teachers' group for the attainment of this intention. Discussion: There was proposed a didactic modeling of the process of preparation of this specialist in formation, which it can contribute to a qualitatively top transformation of the process of formation, and to the pedagogic professionalization of the teacher. (shrink)

To provide a possible interpretation of the passive attitude often exhibited by pupils in the context of school trips, the article does not follow the path of moralistic judgement, but starts from the essence of the teaching profession, which consists in showing the world to the students. The article adopts the thesis of the presence, in many school trips, of an excessive cognitive load and affirms the need to devote the same attention to teaching in these learning contexts as (...) in class work. Graduality is proposed as the key to a learning experience based on a motivation that arises from the discovery of reality. (shrink)

BackgroundAs Canadian global health researchers who conducted a qualitative study with adults with and without disabilities in Uganda, we obtained ethics approval from four institutional research ethics boards (two in Canada and two in Uganda). In Canada, research ethics boards and researchers follow the research ethics norms of the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (TCPS2), and the National Guidelines for Research Involving Humans as Research Participants of Uganda (NGRU) in Uganda. The preparation and implementation (...) of this qualitative research raised specific ethical issues related to research participant privacy and the importance of availability and management of financial resources.Main bodyOur field experience highlights three main issues for reflection. First, we demonstrate that, in a global health research context, methodological and logistic adjustments were necessary throughout the research implementation process to ensure the protection of study participants’ privacy, especially that of people with disabilities, despite having followed the prescribed Canadian and Ugandan ethics norms. Data collection and management plans were adapted iteratively based on local realities. Second, securing financial support as a key aspect of financial management was critical to ensure privacy through disability-sensitive data collection strategies. Without adequate funding, the recruitment of research participants based on disability type, sex, and region or the hiring of local sign language interpreters would not have been possible. Third, although the TCPS2 and NGRU underscore the significance of participants’ privacy, none of these normative documents clearly express this issue in the context of global health research and disability, nor broadly discuss the ethical issue related to financial availability and management.ConclusionsConducting research in resource limited settings and with study participants with different needs calls for a nuanced and respectful implementation of research ethics in a global health context. We recommend a greater integration in both the TCPS2 and NGRU of global health research, disability, and responsible conduct of research. This integration should also be accompanied by adequate training which can further guide researchers, be they senior, junior, or students, and funding agencies. (shrink)

The current COVID-19 pandemic has affected the entire globe, including the world of high-performance sports. Accordingly, it has been widely assumed that the thereby caused postponement of the Tokyo 2020 Olympic Games could have negative psychological impacts for aspirants, since they were halted abruptly in the pursuit of their Olympic endeavors and their daily lives drastically altered. Considering the sudden nature of the pandemic, few researchers, if any, have yet scrutinized the individual experience of Olympic aspirants. This qualitative study (...) examines the subjective perceptions of the Tokyo 2020 Olympic Games postponement among Austrian Olympic athletes and coaches. To this end, 21 Austrian athletes (13 male, 8 female; mean age = 26.67 ± 4.93 years) and six male coaches were recruited through a criterion-based purposive sampling strategy. Five athletes had already qualified for the Olympic Games in Tokyo 2020 and 15 athletes were still in an ongoing qualification process. Data was collected by means of short written statements, elicited via open-format questions on an anonymous online survey platform. In order to infer meaning from the text, a qualitative content analysis with an interpretative focus was conducted inductively, which allowed for deriving alternative explanations of findings. The results support the notion that the Olympic postponement was experienced in myriad ways by affected participants. Three general themes comprised of several meaning units of different levels of abstraction were created from the text data. Many respondents experienced an immediate emotional reaction to the postponement characterized by confusion, disappointment and/or relief. Participants associated multiple consequences with the postponement, such as the prolongation of physical and psychological pressure, a lack of motivation, concerns about future performance, living and their occupational career, but also the opportunity for performance improvement and recovery. Respondents displayed various coping strategies, such as distancing themselves from sports, cognitive reframing, appealing for acceptance, and planning behavior. This study gleans first insights into the idiosyncratic experience of the Olympic Games 2020 postponement among Austrian aspirants. The findings could serve to assist sport psychologists in their applied practice by informing them about athletes’ and coaches’ needs in their Olympic preparation during the ongoing pandemic. (shrink)

David Carr's account of the nature of professional work is described and examined. It is argued that Carr's criteria for distinguishing between professional and non–professional work are not adequate. The criteria are as follows: the professions’ essential role in promoting human flourishing; their contestability; their direct concern for the well–being of clients; their provision of a high degree of autonomy for practitioners. They do not mark out a qualitative difference between professions and other occupations. Carr's notion of civic necessities (...) applies to what he describes as non–professional as well as to professional work. The role of commercial considerations in the usefulness of some kinds of work is considered and a distinction is made between technical and occupational virtues. Carr treats professional virtues as occupational virtues without appreciating that nearly all occupations have both occupational and technical virtues. A significant part of the wouthwhileness of work is bound up with practice of the relevant occupational virtues. (shrink)

Background In 2002, Belgium set a legal framework for euthanasia, whereby granting and performing euthanasia is entrusted entirely to physicians, and—as advised by Belgian Medical Deontology—in the context of a trusted patient–physician relationship. Euthanasia is, however, rarely practiced, so the average physician will not attain routine in this matter. Aim To explore how general practitioners in Flanders (Belgium) deal with euthanasia. This was performed via qualitative analysis of semistructured interviews with 52 general practitioners (GPs). Results Although GPs can understand (...) a patient's request for euthanasia, their own willingness to perform it is limited, based on their assumption that legal euthanasia equates to an injection that ends life abruptly. Their willingness to perform euthanasia is affected by the demanding nature of a patient's request, by their views on what circumstances render euthanasia legitimate and by their own ability to inject a lethal dose. Several GPs prefer increasing opioid dosages and palliative sedation to a lethal injection, which they consider to fall outside the scope of euthanasia legislation. Conclusions Four attitudes can be identified: (1) willing to perform euthanasia; (2) only willing to perform as a last resort; (3) feeling incapable of performing; (4) refusing on principle. The situation where GPs have to consider the request and—if they grant it—to perform the act may result in arbitrary access to euthanasia for the patient. The possibility of installing transparent referral and support strategies for the GPs should be further examined. Further discussion is needed in the medical profession about the exact content of the euthanasia law. (shrink)

This article describes a case study in which community consultation was used to assist in the preparation of a research project on viewing self in the mirror after mastectomy. Breast cancer survivors, nurses, and other health care professionals were consulted using a variety of interactive modalities. Over a period of three months, pre-research planning information was obtained from participants. A descriptive qualitative design was used to analyze the data. The ethical goals of community consultation provided the framework for (...) dialogue and the synthesis of information. During this project, the potential benefits of the proposed research study were explored. Possible risks to future participants were discussed, and recommendations for participant protection suggested. Community members provided insight into the legitimacy of the study. Community consultation is a tool that researchers may consider when designing studies. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Convention for Protection of Human Rights and Dignity of the Human Being with Regard to the Application of Biology and Biomedicine: Convention on Human Rights and BiomedicineCouncil of EuropePreambleThe Member States of the Council of Europe, the other States and the European Community signatories hereto,Bearing in mind the Universal Declaration of Human Rights proclaimed by the General Assembly of the United Nations on 10 December 1948;Bearing in mind the (...) Convention for the Protection of Human Rights and Fundamental Freedoms of 4 November 1950;Bearing in mind the European Social Charter of 18 October 1961;Bearing in mind the International Covenant on Civil and Political Rights and the International Covenant on Economic, Social and Cultural Rights of 16 December 1966;Bearing in mind the Convention for the Protection of Individuals with Regard to Automatic Processing of Personal Data of 28 January 1981;Bearing also in mind the Convention on the Rights of the Child of 20 November 1989;Considering that the aim of the Council of Europe is the achievement of a greater unity between its members and that one of the methods by which that aim is to be pursued is the maintenance and further realisation of human rights and fundamental freedoms;Conscious of the accelerating developments in biology and medicine;Convinced of the need to respect the human being both as an individual and as a member of the human species and recognising the importance of ensuring the dignity of the human being; [End Page 277]Conscious that the misuse of biology and medicine may lead to acts endangering human dignity;Affirming that progress in biology and medicine should be used for the benefit of present and future generations;Stressing the need for international co-operation so that all humanity may enjoy the benefits of biology and medicine;Recognising the importance of promoting a public debate on the questions posed by the application of biology and medicine and the responses to be given thereto;Wishing to remind all members of society of their rights and responsibilities;Taking account of the work of the Parliamentary Assembly in this field, including Recommendation 1160 (1991) on the preparation of a Convention on bioethics;Resolving to take such measures as are necessary to safeguard human dignity and the fundamental rights and freedoms of the individual with regard to the application of biology and medicine;Have agreed as follows:Chapter IGeneral provisionsArticle 1. (Purpose and object)Parties to this Convention shall protect the dignity and identity of all human beings and guarantee everyone, without discrimination, respect for their integrity and other rights and fundamental freedoms with regard to the application of biology and medicine.Each Party shall take in its internal law the necessary measures to give effect to the provisions of this Convention.Article 2. (Primacy of the human being)The interests and welfare of the human being shall prevail over the sole interest of society or science.Article 3. (Equitable access to health care)Parties, taking into account health needs and available resources, shall take appropriate measures with a view to providing, within their jurisdiction, equitable access to health care of appropriate quality. [End Page 278]Article 4. (Professional standards)Any intervention in the health field, including research, must be carried out in accordance with relevant professional obligations and standards.Chapter IIConsentArticle 5. (General rule)An intervention in the health field may only be carried out after the person concerned has given free and informed consent to it.This person shall beforehand be given appropriate information as to the purpose and nature of the intervention as well as on its consequences and risks.The person concerned may freely withdraw consent at any time.Article 6. (Protection of persons not able to consent)1. Subject to Articles 17 and 20 below, an intervention may only be carried out on a person who does not have the capacity to consent, for his or her direct benefit.2. Where, according to law, a minor does not have the capacity to consent to an intervention, the intervention may only be carried out with the authorisation of his or her representative or an authority or a person or... (shrink)

William of Poitiers began his career as a knight before studying in the schools of Poitiers and entering the Church. He became a chaplain in the household of William the Conqueror, and was able to give a first-hand account of the events of 1066-7. The Gesta Guillelmi, his unfinished biography of the king, is particularly important for its detailed description of William's campaigns in Normandy, the careful preparations he made for the invasion of England, the battle of Hastings and the (...) establishment of Norman power after the Conquest. It is a mine of information of military tactics and the conduct of war in the eleventh century. Though written from the point of view of the Norman court, it gives what is probably the most authentic account of these momentous events. This edition, by the late R. H. C. Davis and Marjorie Chibnall, with facing-page English translation of the Latin text, provides the first complete English translation, as well as a full historical introduction and detailed notes. (shrink)

_Teachers as Researchers_ urges teachers - as both producers and consumers of knowledge - to engage in the debate about educational research by undertaking meaningful research themselves. Teachers are being encouraged to carry out research in order to improve their effectiveness in the classroom, but this book suggests that they also reflect on and challenge the reductionist and technicist methods that promote a 'top down' system of education. It argues that only by engaging in complex, critical research will teachers rediscover (...) their professional status, empower their practice in the classroom and improve the quality of education for their pupils. Now re-released to introduce this classic guide for teachers, the new edition of _Teachers as Researchers_ now also includes an introductory chapter by Shirley R. Steinberg that sets the book within the context of both the subject and the historical perspective. In addition, she also provides information on some key writing that extends the bibliography of this influential book thereby bringing the material fully up to date with current research. Postgraduate students of education and experienced teachers will find much to inspire and encourage them in this definitive book. (shrink)

Background. The COVID-19 pandemic necessitated drastic changes to undergraduate medical training at the University of Botswana (UB). To save the academic year when campus was locked down, the Department of Medical Education conducted a needs assessment to determine the readiness for emergency remote teaching (ERT) of the Faculty of Medicine, UB. Objectives. To report on the findings of needs assessment surveys to assess learner and teaching staff preparedness for fair and just ERT, as defined by philosopher John Rawls. Methods. Needs (...) assessment surveys were conducted using Office 365 Forms distributed via WhatsApp, targeting medical students and teaching staff during the 5 undergraduate years. Data were analysed quantitatively and qualitatively. Results. Ninety-two percent (266/289) of students and 73.5% (62/84) of teaching staff responded. Surveys revealed a high penetration of smartphones among students, but poor internet accessibility and affordability in homes. Some teaching staff also reported internet and device insufficiencies. Only WhatsApp was accessible to students and teaching staff. Conclusions. For equitable access to ERT in the future, the surveys revealed infrastructural improvement needs, including wider, stronger, affordable WiFi coverage within Botswana and enhanced digital infrastructures in educational institutions, with increased support for students. (shrink)

This volume contains the first critical edition of the Scriptum super III-VIII libros Politicorum by Peter of Auvergne as well as a pragmatical edition of Books III-VIII of the medieval Latin translation of Aristotle's Politics. Intended as the continuation of Aquinas' unfinished commentary on the first three books of the Politics, the Scriptum became-together with Aquinas' commentary-the commentary on the Politics. From its appearance in the late thirteenth century to the end of the sixteenth century, the Scriptum represented the most (...) authoritative and influential interpretation of Books III-VIII of the Politics.The introduction to the volume provides both an overview of Peter's political thought and a case study of the production and dissemination of a university text. An examination of the manuscripts traces the preparation of the text from its first transcription and revision by a scribe close to the author-if not the author himself-to the preparation of the finished exemplar and its diffusion through the system of peciae. The introduction also explains how the text was adapted to fit the standards of humanistic Latin when it was first printed in the fifteenth century: its language was adjusted to humanistic standards, many formulations were reshaped, and passages were suppressed. These changes were subsequently preserved in all later editions of the text. Freed from this humanistic patina with which it has been transmitted since the early age of printing age, the Scriptum is now restored to its original version. (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)

Doctoral programs at U.S. universities play a critical role in the development of human resources both in the United States and abroad. This volume reports the results of an extensive study of U.S. research-doctorate programs in five broad fields: physical sciences and mathematics, engineering, social and behavioral sciences, biological sciences, and the humanities. Research-Doctorate Programs in the United States documents changes that have taken place in the size, structure, and quality of doctoral education since the widely used 1982 editions. This (...) update provides selected information on nearly 4,000 doctoral programs in 41 subdisciplines at 274 doctorate-granting institutions. This volume also reports the results of the National Survey of Graduate Faculty, which polled a sample of faculty for their views on the scholarly quality of program faculty and the effectiveness of doctoral programs in preparing research scholars/scientists. This much-anticipated update of such an essential reference will be useful to education administrators, university faculty, and students seeking authoritative information on doctoral programs. (shrink)

During preparation for early abortion in Norway, an ultrasound examination is usually performed to determine gestation and viability. This article aims to provide a deeper understanding of women’s and health care personnel’s experiences with ultrasound viewing during abortion preparation in the first trimester. Qualitative in-depth interviews with women who had been prepared for early abortion and focus group interviews with HCP from gynaecological units were carried out. A hermeneutic-phenomenological analysis, inspired by van Manen, was chosen. Thirteen women (...) who were pregnant and considering abortion in their first trimester and 20 HCP, namely, 19 registered nurses and one medical doctor, were recruited from gynaecological units at six hospitals. The study was approved by the ethics committee. The essential meaning structure of ‘autonomy under pressure’ consisted of two themes that expressed the different experiences of both the women and the HCP, namely, expectations versus precautions and choice versus protection. The women and HCP expressed different attitudes before the consultation that affected their experiences of the ultrasound examination. While the women had expectations of a clarification based on their choice to either see or not see the ultrasound image, HCP seemed to be more concerned with predetermined rules that they believed would protect the women. Consequently, the basis for dialogue was not optimal, and women’s autonomy was under pressure. Health care personnel are ethically challenged during preabortion ultrasound examinations. Meeting the individual woman’s needs and respecting her autonomy during preparation for abortion requires sensitivity, involvement, and dialogue skills by health personnel. According to the woman’s desire to be informed about the possibility of viewing the image during the abortion preparations, a dialogue that is focused in this direction should arise before the examination. (shrink)

Background Moral distress is a serious problem for health care personnel. Surveys, individual interviews, and focus groups may not capture all of the effects of, and responses to, moral distress. Therefore, we used a new participatory action research approach—moral conflict assessment (MCA)—to characterize moral distress and to facilitate the development of interventions for this problem. Aim To characterize moral distress by analyzing responses of intensive care unit (ICU) personnel who participated in the MCA process. Research Design In this qualitative (...) study, we invited all ICU personnel at 3 urban hospitals to participate in individual or group sessions using the 8-step MCA tool. These sessions were facilitated by either a clinical ethicist or a counseling psychologist who was trained in this process. During each session, one of the researchers took notes and prepared a report for each MCA which were analyzed using qualitative content analysis. Participants and Research Context A total of 24 participants took part in 15 sessions, individually or in groups; 14 were nurses and nurse leaders, 2 were physicians, and 8 were other health professionals. Ethical Considerations This study was approved by the Providence Health Care/University of British Columbia Behavioural Research Ethics Board. Each participant provided written informed consent. Results The main causes of moral distress related to goals of care, communication, teamwork, respect for patient’s preferences, and the managerial system. Suggested solutions included communication strategies and educational activities for health care providers, patients, family members, and others about teamwork, advance directives, and end-of-life care. Participants acknowledged that using the MCA process helped them to reflect on their own thoughts and use their moral agency to turn a distressing situation into a learning and improvement opportunity. Conclusions Using the MCA tool helped participants to characterize their moral distress in a systematic way, and to arrive at new potential solutions. (shrink)