Background: After over 4 years since medical assistance in dying legalization in Canada, there is still much uncertainty about how this ruling has affected Canadian society. Objective: To describe the positive aspects of medical assistance in dying legalization from the perspectives of hospice palliative care providers engaging in medical assistance in dying. Design: In this qualitative descriptive study, we conducted an inductive thematic analysis of semi-structured interviews with hospice palliative care providers. Participants and setting: Multi-disciplinary hospice palliative care providers in (...) acute, community, residential, and hospice care in Vancouver and Toronto, Canada, who have engaged in end-of-life care planning with patients who have inquired about and/or requested medical assistance in dying. Ethical considerations: The research proposal was approved by University of British Columbia Research Ethics Board in Vancouver and University Health Network in Toronto. Participants were informed regarding the research goals, signed a written consent, and were assigned pseudonyms. Results: The 48 participants included hospice palliative care physicians, nurses, social workers, and allied health providers. The average interview length was 50 min. Positive aspects of medical assistance in dying legalization were identified at the individual level: a new end-of-life option, patients’ last chance to express control over their lives, patient and family comfort and relief, and a unique learning experience for hospice palliative care providers; the team level: supportive collegial relationships, broadened discussions about end-of-life and palliative care, and team debriefs provide opportunities for education and support; and the institutional level: improved processes to facilitate the implementation logistics. Conclusion: While being involved in the medical assistance in dying process is complex and challenging, this study sheds light on the positive aspects of medical assistance in dying legalization from the hospice palliative care provider’s perspectives. Medical Assistance in Dying legalization has resulted in improved end-of-life conversations between hospice palliative care providers, patients, and their families. Improved communication leads to a better understanding of patients’ end-of-life care plans and bridges some of the existing gaps between hospice palliative care and medical assistance in dying. (shrink)

In clinical practice, decision-making is not performed by individual knowers but by an assemblage of people and instruments in which no one member has full access to every piece of evidence. This is due to decision making teams consisting of members with different kinds of expertise, as well as to organisational and time constraints. This raises important questions for the epistemology of medicine, which is inherently social in this kind of setting, and implies epistemic dependence on others. Trust in these (...) contexts is a highly complex social practice, involving different forms of relationships between trust and reasons for trust: based on reasons, and not based on reasons; based on reasons that are easily accessible to reflection and others that are not. In this paper, we focus on what it means to have reasons to trust colleagues in an established clinical team, collectively supporting or carrying out every day clinical decision-making. We show two important points about these reasons, firstly, they are not sought or given in advance of a situation of epistemic dependence, but are established within these situations; secondly they are implicit in the sense of being contained or nested within other actions that are not directly about trusting another person. The processes of establishing these reasons are directly about accomplishing a task, and indirectly about trusting someone else’s expertise or competence. These processes establish a space of reasons within which what it means to have reasons for trust, or not, gains a meaning and traction in these team-work settings. Based on a qualitative study of decision-making in image assisted diagnosis and treatment of a complex disease called pulmonary hypertension, we show how an intersubjective framework, or ‘space of reasons’ is established through team members forging together a common way of identifying and dealing with evidence. In dealing with images as a central diagnostic tool, this also involves a common way of looking at the images, a common mode or style of perception. These frameworks are developed through many iterations of adjusting and calibrating interpretations in relation to those of others, establishing what counts as evidence, and ranking different kinds of evidence. Implicit trust is at work throughout this process. Trusting the expertise of others in clinical decision-making teams occurs while the members of the team are busy on other tasks, most importantly, building up a framework of common modes of seeing, and common ways of identifying and assessing evidence emerge. It is only in this way that trusting or mistrusting becomes meaningful in these contexts, and that a framework for epistemic dependence is established. (shrink)

This study explores the integration of data journalism within three European legacy news organisations through the lens of organisational structure and professional culture. Interviews with data journalists and editors suggest that professional routines resonate with established data journalism epistemologies, values, and norms that appear to be constitutional for an inter-organisational data journalism subculture. At the same time, organisational structure either integrates the journalistic subculture by increasing levels of complexity, formalisation, and centralisation or rejects it by not accommodating it structurally or (...) culturally. The three data teams work along epistemologies of computer-assisted reporting, investigative journalism, and data journalism but differentiate themselves through nuanced understandings of data journalism practice, driven by individual journalists. After a structureless episode, one team sets itself apart as it diverges from data-driven routines and orients itself towards technological and interdisciplinary interactive journalism. The findings show an interdependence of individual efforts, varying conceptualisations of data journalism practice, and interplay between organisational structure and professional culture. (shrink)

In clinical practice, decision-making is not performed by individual knowers but by an assemblage of people and instruments in which no one member has full access to every piece of evidence. This is due to decision making teams consisting of members with different kinds of expertise, as well as to organisational and time constraints. This raises important questions for the epistemology of medicine, which is inherently social in this kind of setting, and implies epistemic dependence on others. Trust in these (...) contexts is a highly complex social practice, involving different forms of relationships between trust and reasons for trust: based on reasons, and not based on reasons; based on reasons that are easily accessible to reflection and others that are not. In this paper, we focus on what it means to have reasons to trust colleagues in an established clinical team, collectively supporting or carrying out every day clinical decision-making. We show two important points about these reasons, firstly, they are not sought or given in advance of a situation of epistemic dependence, but are established within these situations; secondly they are implicit in the sense of being contained or nested within other actions that are not directly about trusting another person. The processes of establishing these reasons are directly about accomplishing a task, and indirectly about trusting someone else’s expertise or competence. These processes establish a space of reasons within which what it means to have reasons for trust, or not, gains a meaning and traction in these team-work settings. Based on a qualitative study of decision-making in image assisted diagnosis and treatment of a complex disease called pulmonary hypertension (PH), we show how an intersubjective framework, or ‘space of reasons’ is established through team members forging together a common way of identifying and dealing with evidence. In dealing with images as a central diagnostic tool, this also involves a common way of looking at the images, a common mode or style of perception. These frameworks are developed through many iterations of adjusting and calibrating interpretations in relation to those of others, establishing what counts as evidence, and ranking different kinds of evidence. Implicit trust is at work throughout this process. Trusting the expertise of others in clinical decision-making teams occurs while the members of the team are busy on other tasks, most importantly, building up a framework of common modes of seeing, and common ways of identifying and assessing evidence emerge. It is only in this way that trusting or mistrusting becomes meaningful in these contexts, and that a framework for epistemic dependence is established. (shrink)

In 2016, the Atlanta Community Food Bank launched the Stabilizing Lives project to develop programs and policies that could better address clients’ needs as well as including clientele as part of the planning process. The ACFB partnered with a research team at the University of Georgia to conduct a participatory research project aimed at developing deeper insights into the factors contributing to both instability and stability in the lives of pantry clientele. This article describes the outcomes this research, offering (...) both a substantive contribution to scholarship on food insecurity and emergency food systems and a methodological innovation through a staged mixed-method participatory research project. Through use of a culture-centered approach, this project created discursive spaces within which to outline emergency food models that support informal networks of care. We used a range of methods, including photo elicitation, concept mapping, individual interviews, and focus groups, to facilitate conversation among agency staff, volunteers, and clientele about the effectiveness of current program models and potential new ideas. Specifically, we suggest that through such practices, food pantries and local agencies may help inform new program models that contribute to household stability, and push back against the sometimes alienating and atomizing paradigm found in current emergency food programs. (shrink)

Pastoral care is a biblical mandate to the Church to be involved in the lives of God's peop A key metaphor used by Jesus to describe his pastoral role was that of a shepherd. Thi to be God's shepherds and instruments of healing and transformation in God's world is imperative to all people, clergy and laity alike. The brokenness in South African society strikingly apparent, exacerbated by the effects of exceptionally high criminal behaviour statistics show. The demand for pastoral care (...) and assistance with various personal proble is on the increase, with many non-church goers turning to churches for help. Also appare in South Africa is the acute shortage of trained individuals to offer care and counselling. T task of offering care is not the sole responsibility of clergy, as all are called to be shepherds a caregivers. The importance and urgency in training church-based counselling teams cannot overstated. More so in that we are becoming increasingly aware that not only are individu in need of care, but whole communities are struggling with trauma and life's challenges, a often do not know whom to turn to. In pursuance of the realisation that pastoral care is t function and duty of all Christians, this article will delineate in particular an explanation lay counselling, reasons for its importance including biblical foundations, where and ho ordinary South Africans can get involved, and will propose certain models and approach for getting started. These models will not be discussed in depth, but present an opportun for the next. Teams for these models consist of professional counsellors, but ought not to restricted to a select few, as all are called to this special ministry and can be trained for t task, which will include on-going supervision and mentoring. The overall purpose of t article is to highlight the urgency of training lay counsellors and some recommendations w be made how to apply it, in an attempt to be faithful to the biblical mandate and examples by Jesus Christ. (shrink)

Although most studies investigated the impact of infertility and its treatment on the couple, a small body of evidence suggested that infertility care providers may experience different sources of stress related for instance to excessive workload, the complexity of the technique, and relational difficulties with patients. The current study aimed at providing further insight into the understanding of the subjective experience of infertility care providers by highlighting their feelings and emotions, personal meanings, challenges, and opportunities. Following the methodological guidelines of (...) Interpretative Phenomenological Analysis, we conducted individual semi-structured interviews with 23 members of two different fertility units. Interviews were audiotaped and transcribed verbatim. Textual analysis was then conducted to identify emerging dominant themes and subthemes. Three main themes were extracted: dealing with infertile patients and their specificities, performing assisted reproductive technology, being part of a team. These themes related to participants experiencing: difficulties in establishing an empathic connection and communicating with couples, such that women were sometimes perceived as “particular patients” and men as poorly involved in the process; difficulties in dealing with a complex procedure in which errors are not allowed, with a growing number of women aged > 40 seeking assisted reproduction, despite the risks for their health; being part of a team as a resource, although the huge amount of time spent together can involve conflicts and organizational problems. These findings suggested that patients’ overpersistence represents an important source of stress for infertility care providers. At the same time, the concept of particular or difficult patient derives from the combination of multiple factors, including providers’ own history and subjective experience. The presence of mental health professionals in fertility units is essential to help providers improve the quality of doctor-patient communication and relieve the stress related to organizational issues and conflicts. (shrink)

The ability to anticipate team members' actions enables joint action towards a common goal. Task knowledge and mental simulation allow for anticipating other agents' actions and for making inferences about their underlying mental representations. In human–AI teams, providing AI agents with anticipatory mechanisms can facilitate collaboration and successful execution of joint action. This paper presents a computational cognitive model demonstrating mental simulation of operators' mental models of a situation and anticipation of their behavior. The work proposes two successive steps: (...) (1) A hierarchical cluster algorithm is applied to recognize patterns of behavior among pilots. These behavioral clusters are used to derive commonalities in situation models from empirical data (N = 13 pilots). (2) An ACT-R (adaptive control of thought - rational) cognitive model is implemented to mentally simulate different possible outcomes of action decisions and timing of a pilot. model tracing of ACT-R allows following up on operators' individual actions. Two models are implemented using the symbolic representations of ACT-R: one simulating normative behavior and the other by simulating individual differences and using subsymbolic learning. Model performance is analyzed by a comparison of both models. Results indicate the improved performance of the individual differences over the normative model and are discussed regarding implications for cognitive assistance capable of anticipating operator behavior. (shrink)

Background A team-based approach has been advocated for advance care planning in nursing homes. While nurses are often put forward to take the lead, it is not clear to what extent other professions could be involved as well. Objectives To examine to what extent engagement in advance care planning practices, knowledge and self-efficacy differ between nurses, care assistants and allied care staff in nursing homes. Design Survey study. Participants/setting The study involved a purposive sample of 14 nursing homes in (...) Flanders, Belgium. Nurses, care assistants and allied care staff completed a survey. Ethical considerations The study was approved by the University Hospital of Brussels, as part of a cluster randomized controlled trial. Results One hundred ninety-six nurses, 319 care assistants and 169 allied staff participated. After adjusting for confounders, nurses were significantly more likely than care assistants to have carried out advance care planning conversations and documented advance care planning ; differences not found between allied staff and care assistants. Advance care planning knowledge total scores differed significantly, with nurses ; 95% confidence interval 0.08–0.17; p < 0.001) and allied staff scoring higher than care assistants. We found no significant differences regarding self-efficacy. Discussion While nursing home nurses conducted more advance care planning conversations and documentation than allied care staff and care assistants, these two professional groups may be a valuable support to nurses in conducting advance care planning, if provided with additional training. Conclusions Allied care staff and care assistants, if trained appropriately, can be involved more strongly in advance care planning to enhance relational and individual autonomy of nursing home residents, alongside nurses. Future research to improve and implement advance care planning should consider this finding at the intervention development stage. (shrink)

On many occasions, the maximum result of a team does not equate to the total maximum individual effort of each athlete (social loafing). Athletes often combine their sports life with an academic one (Dual Career), prioritizing one over the over in a difficult balancing act. The aim of this research is to examine the existence of social loafing in a group of novice university rowers and the differences that exist according to sex, academic performance, and the kind of sport (...) previously practiced (individual or team). Therefore, a study was conducted from a probabilistic perspective using the Bayesian Network analysis methodology. The results confirm the existence of the Ringelmann effect or social loafing. The Bayesian analysis let us confirm that having a good student who practices a team sport, even in the individual rowing concept, increases the probability of obtaining greater performance (higher number of strokes and more power in each one). Therefore, when rowing partnerships are formed, the occurrence probability chain is quickly simplified, along with values of the top and bottom variables. Finally, the instantiations undertaken on the bottom variable that appears to be common in the two BNs, the watt input, enhance the results obtained. In short, rowers who have a better academic record are more involved in team testing, so this characteristic is defining when it comes to achieving better performance in team testing. (shrink)

BackgroundIn childhood cancer care, healthcare professionals must deal with several difficult moral situations in clinical practice. Previous studies show that morally difficult challenges are related to decisions on treatment limitations, infringing on the child's integrity and growing autonomy, and interprofessional conflicts. Research also shows that healthcare professionals have expressed a need for clinical ethics support to help them deal with morally difficult situations. Moral case deliberations (MCDs) are one example of ethics support. The aim of this study was to describe (...) the MCD-related outcomes that healthcare professionals in childhood cancer care considered important, before MCDs were implemented, in order to facilitate the implementation of MCDs in childhood cancer care in Sweden.MethodsThis study is based on qualitative data. Healthcare professionals, mostly representing registered nurses, nursing assistants and physicians, working at childhood cancer care centres in Sweden, were invited to respond to the translated and content validated European MCD Outcomes Instrument, before participating in regular MCDs. Answers to the main open-ended question, included in the questionnaire, was analysed according to systematic text condensation.ResultsData was collected from 161 responses from the healthcare professionals. The responses included healthcare professionals’ perceptions of which MCD-related outcomes they found important for handling moral challenges. Three different themes of important outcomes from the analysis of the data are presented as follows:Interprofessional well-being in team interactionson a team level;Professional comfort when dealing with moral challengeson a personal level; andImproved quality of care for the child and the familyon a care level.ConclusionsHealthcare professionals in childhood cancer care considered it important that ethics support could enhance the well-being of interprofessional teams, support healthcare professionals on an individual level and improve quality of care. The results of this study can be used in current and future training for MCD-facilitators. When knowing the context specific important MCD-outcomes, the sessions could be adapted. Managers in childhood cancer care would benefit from knowing about the specific important outcomes for their target group because they could then create relevant working conditions for clinical ethics support. (shrink)

In post-Fordist economies, the nature of laboring activities can no longer be subsumed under a Taylorized model of labor, and the service sector now constitutes a larger share of the market. For Maurizio Lazzarato, Michael Hardt, Antonio Negri, and other theorists in the post-Marxist tradition, labor has changed from a commodity-producing activity to one that does not produce a material object. For these authors, this new type of labor is immaterial labor and entails communicative acts as well as added worker (...) agency. This paper reflects on this new paradigm of labor by examining the paid practices of care defined as the activities performed by individuals who have a mandate to help another adult accomplish the tasks of self-care. Because care workers take care of other bodies, care labor exemplifies an embodied practice. I make use of the corporeality of care to put forward the notion of thin and thick embodiment in order to examine critically the meaning of immaterial labor and to support my claim that immaterial labor, as conceptualized by Hardt and Negri, erases both the materiality and relationality of care labor. Furthermore, typifying care labor as immaterial only serves to maintain its marginalized status.Care Assistant. Required to work within a private residential center to assist nursing staff. Experience desirable, qualifications an advantage, but caring and understanding more important than either. Must have good English to understand instructions and be co-operative to work in a friendly team environment (Toynbee 2007, 220). (shrink)

As the first stage of the formation of a collaborative new product innovation team, member selection is crucial for the effective operation of the CNPI team and the achievement of new product innovation goals. Considering comprehensively the individual and collaborative attributions, the individual knowledge competence, knowledge complementarity, and collaborative performance among candidates are chosen as the criteria to select CNPI team members in this paper. Moreover, using the fuzzy set and social network analysis method, the quantitative methods (...) of the above criteria are proposed correspondingly. Then, by integrating the above criteria, a novel multiobjective decision model for member selection of the CNPI team is built from the view of individual and collaborative attributions. Since the proposed model is NP-hard, a double-population adaptive genetic algorithm is further developed to solve it. Finally, a real case is provided to illustrate the application and effectiveness of the proposed model and method in this paper. (shrink)

The COVID-19 pandemic has highlighted the risks that can be involved in healthcare work. In this paper, we explore the issue of staff safety in clinical work using the example of personal protective equipment in the COVID-19 crisis. We articulate some of the specific ethical challenges around PPE currently being faced by front-line clinicians, and develop an approach to staff safety that involves balancing duty to care and personal well-being. We describe each of these values, and present a decision-making framework (...) that integrates the two. The aim of the framework is to guide the process of balancing these two values when staff safety is at stake, by facilitating ethical reflection and/or decision-making that is systematic, specific and transparent. It provides a structure for individual reflection, collaborative staff discussion, and decision-making by those responsible for teams, departments and other groups of healthcare staff. Overall the framework guides the decision maker to characterise the degree of risk to staff, articulate feasible options for staff protection in that specific setting and identify the option that ensures any decrease in patient care is proportionate to the increase in staff well-being. It applies specifically to issues of PPE in COVID-19, and also has potential to assist decision makers in other situations involving protection of healthcare staff. There are no data in this work. (shrink)

Nowadays, many countries are promoting entrepreneurial education or the “innovation, entrepreneurship, and creativity” education. Entrepreneurial education can enhance a nation’s economic competitiveness and give rise to new business. At the moment, entrepreneurial courses are mostly designed by school teachers; however, while school teachers may possess business experience, they lack in entrepreneurial experience. Hence, entrepreneurial education courses call for experts with entrepreneurial experience to contribute to course designs and assist with course teachings. Entrepreneurial education not only improves a student’s entrepreneurial skills, (...) but also enables each student to explore their personal characteristics in order to advance the collaboration efficacy of the team as a whole. This study asked six experts with entrepreneurial experience in the information industry to work with school teachers in course design as well as teaching collaboration. The course design starts with three talk sessions given by professionals who share with students their thoughts and experiences in entrepreneurial products, team organization, fund raising, and profit calculation. Following that, each student is asked to share their own thoughts on entrepreneurial products and start searching for team members and planning their project. During the course, each team receives six individual advising sessions from the professionals, with topics ranging from product modeling, feasibility, product market estimation, fundraising methods, and profit calculation. The experts also provide each team member with personal trait analysis. Last but not least, the course invites five management-level industry professionals to play the role of venture capital investor and evaluate each team’s product modeling based on their presentation. This study reviews the grades given by the experts as well as the evaluations given by the three industry managers to assess whether the entrepreneurial education course’s student entrepreneur teams satisfy the industry’s expectations. (shrink)

The aim of this study was to assess nurses’ and physicians’ ethical dilemmas in clinical practice. Nurses and physicians of the Clinical Hospital Centre Rijeka were surveyed (N = 364). A questionnaire was used to identify recent ethical dilemma, primary ethical issue in the situation, satisfaction with the resolution, perceived usefulness of help, and usage of clinical ethics consultations in practice. Recent ethical dilemmas include professional conduct for nurses (8%), and near-the-end-of-life decisions for physicians (27%). The main ethical issue is (...) limiting life-sustaining therapy (nurses 15%, physicians 24%) and euthanasia and physician-assisted suicide (nurses 16%, physicians 9%). The types of help available are similar for nurses and physicians: obtaining complete information about the patient (37% vs. 50%) and clarifying ethical issues (31% vs. 39%). Nurses and physicians experience similar ethical dilemmas in clinical practice. The usage of clinical ethics consultations is low. It is recommended that the individual and team consultations should be introduced in Croatian clinical ethics consultations services. (shrink)

BackgroundResearch proactively and deliberately aims to bring about specific changes to how societies function and individual lives fare. However, in the ever-expanding field of ethical regulations and guidance for researchers, one ethical consideration seems to have passed under the radar: How should researchers act when pursuing actual, societal changes based on their academic work?Main textWhen researchers engage in the process of bringing about societal impact to tackle local or global challenges important concerns arise: cultural, social and political values and institutions (...) can be put at risk, transformed or even hampered if researchers lack awareness of how their ‘acting to impact’ influences the social world. With today’s strong focus on research impacts, addressing such ethical challenges has become urgent within in all fields of research involved in finding solutions to the challenges societies are facing. Due to the overall goal of doing something good that is often inherent in ethical approaches, boundaries to researchers’ impact of something good is neither obvious, nor easy to detect. We suggest that it is time for the field of bioethics to explore normative boundaries for researchers’ pursuit of impact and to consider, in detail, the ethical obligations that ought to shape this process, and we provide a four-step framework of fair conditions for such an approach. Our suggested approach within this field can be useful for other fields of research as well.ConclusionWith this paper, we draw attention to how the transition from pursuing impact within the Academy to trying to initiate and achieve impact beyond the Academy ought to be configured, and the ethical challenges inherent in this transition. We suggest a stepwise strategy to identify, discuss and constitute consensus-based boundaries to this academic activity. This strategy calls for efforts from a multi-disciplinary team of researchers, advisors from the humanities and social sciences, as well as discussants from funding institutions, ethical committees, politics and the society in general. Such efforts should be able to offer new and useful assistance to researchers, as well as research funding agencies, in choosing ethically acceptable, impact-pursuing projects. (shrink)

Background On a daily basis, healthcare professionals deal with various ethical issues and it can be difficult to determine how to act best. Clinical ethics support (CES) has been developed to provide support for healthcare professionals dealing with complex ethical issues. A long-term perspective of participating in inter-professional dialogue and reflective-based CES sessions is seemingly sparse in the literature. Research aim The aim was to describe experiences of impact of Inter-professional Ethics Communication in groups (IEC) based on Habermas’ theory of (...) communicative actions, after 6 months from the perspective of an inter-professional team. Research design A qualitative inductive approach was chosen, and individual interviews ( n = 13) were conducted. Interview data were analysed using qualitative content analysis. Participants The participants, 10 females and two males, represented assistant nurses, registered nurses, physicians, occupational therapists, physiotherapists, welfare officers and psychologists. Each had attended at least four IEC sessions. Ethical considerations The study was approved by the Regional Ethical Review Board in Umeå, Sweden, and it has been undertaken in accordance with the Helsinki Declaration. Findings Overall, the descriptions expressed a perceived achievement of a deepened and integrated ethical awareness that increased the participants’ awareness of ethically difficult situations as well as their own ethical thinking, actions and approaches in daily work. Perspectives were shared and the team become more welded. They carried the memories of the reflections within them, which was perceived as supportive when encountered new ethically situations. Discussion Putting words to unarticulated thoughts may stimulate repeated reflections, leading to new insights and alternative thoughts. Conclusion The outcome of IEC sessions 6 months following the last session can be described as an incorporated knowledge that enables actions in ethically difficult situations based on an ethical awareness both at a ‘We-level’ and an ‘I-level’. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Looking Back and Moving ForwardDebbie PittsI started my Nursing Assistant career forty-three years ago and have worked in the same long-term care facility for the past forty years now. Over the years, I have seen many cultural changes being made in the field. Back then everyone was referred to as patients, then residents and more recently elders. As these changes took place, it was difficult for us to change (...) in the sense of calling them patients to residents and now elders but we all manage to accomplish it. Our elders have so many more choices nowadays, which has been a wonderful additive for those who live in a facility.As I look back, I can remember when restraints were used routinely. The good old locked Posey belts, pelvic restraints, vest restraints and how many other types that we used to use. Already many years have passed since we have used these things and that is a blessing as they were nothing more than a pain to use for us and our elders. Sometimes they would be so knotted it was difficult to get them untied. I can remember that many who needed to have these were people that had symptoms of now what we call Alzheimer's or people with some sort of dementia. Back then they were unsure of this disease. These were definitely some challenging times to work in. Taking care of the combative person can be very difficult. At least now, we have much more knowledge through education as to how to handle and deal with these issues. I have been fortunate in my facility that we thrive on education, which helps me learn all the modern techniques and ways of dealing with the many issues we have today with dementias.When I go to work daily, I not only have to take care of my elders, but then I also have to deal with their families as well. This too, can be somewhat difficult at times. Some of them can become quite demanding with the cares needed for their loved one. After dealing with them I often find that they have a guilty feeling for having to place them in a nursing home, but it can still create a problem for you and make it hard to get your cares done for other elders on your daily schedule. As much as I try to reassure them that their family member is getting the best care and attention they need, sometimes it isn't enough to satisfy them. There are times if I feel pressured or frustrated I will talk with my supervisor, or a social worker, and ask them if they could have a talk with the family for me. I find that having [End Page 143] good communication with every department and all supervisors is vitally important in my job. Unlike years ago, today we are all a team and are there for our elders and their every need.On a more personal level, with my daily routine in care, I love when I can take my elder for a walk. Sometimes they may be fearful of falling or something else. Using reassurance and encouragement and getting them going can be a very rewarding situation. It's when they don't believe they are capable of doing this, and then they do, when you realize just how much you have done for them. The smiles, thank yous and hugs I get back can just warm your heart and even put tears in your eyes. The sense of accomplishment provided for them is very rewarding. This is just so true whether it be walking, eating, bathing or dressing. Taking the time to work individually with each elder on whatever levels needed is so important. When they tell their family member about their accomplishment that they achieved today, they are so proud. The smiles, twinkle in their eyes and the excitement shown is just amazing. Sometimes at this point I can develop a relationship with the difficult family member. Normally they will be happy for their loved one's accomplishment and grateful to you for helping them. My personal accomplishment is becoming a... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:These Things I BelieveA. M. ShuhamI am a health care professional who has worked in the field for two decades. I have been part of small miracles and heartbreaking events, which kept me up at night. Although I do not [End Page 120] provide direct patient care, my advanced education and expertise allows me to advise members of the health care team when difficult questions arise about the (...) goals of treatment, questions about competency and interpreting patient preferences. I believe my interest in the field was shaped by my family’s experience dealing with the challenges that come with terminal illness and advancing age. I am humbled to have been part of their journey as they faced death with dignity and grace.Living in a small community presents significant challenges that may never occur in a large urban setting. The team you work with knows your family or the names of your children because in their spare time they are the piano teacher or soccer coach for your children, friends that knew you growing up. This close knit atmosphere can be a blessing when things go well and unbearable when mistakes are made or professionals disagree, because you still interact with one another outside the context of your professional role and this is when moral distress begins.I began working with A. J. ten years ago to facilitate the completion of a health care directive. At the time A. J was beginning to show the signs of a neuro–muscular disease experienced by other members of the family. In early 2000 most directives were fairly straightforward with the option to choose artificial nutrition and hydration or not. A. J. very specifically checked “none.” Years went by living independently for A. J. but as most illnesses progress so did A. J’s, and admission to a health care institution became necessary. In many situations medically assisted nutrition and hydration would be indicated, but in this case the wishes of the patient were known in the form of a health care directive. The decision makers inability to honor the directive was the purpose for my involvement almost a decade after my initial work with A. J.No matter where you stand in the debate regarding medically assisted nutrition and hydration being burdensome or ordinary care, most people believe in the importance of a health care directive given the histories of Nancy Cruzan, Karen Quinlan and Terri Schiavo. My objective was to compile the legal information that would elucidate the patient preferences and help staff and the decision maker understand it was time to honor the directive given the advanced stage of disease. Numerous attempts were made with the surrogate and health care professionals to help them understand state statutes on health care directives supporting a patient’s right to chose. It became clear that some of the team seemed disinterested in my concerns or my responsibility as a professional, and I began to believe the difficulty was a failure on my part to communicate clearly.During that first year conversations and meetings were scheduled with the patients decision makers and they felt unable to make a decision and requested the entire family provide input. Although they understood A. J’s wishes, they felt everyone should be in agreement. In my experience when leaving decisions of this magnitude to a large extended family, communications deteriorate and little can be accomplished. Some members in the family held fundamental religious beliefs and thought a miracle could change the prognosis. While I believe as health care professionals we must respect individual religious beliefs and values, we are also morally obligated to advocate on behalf of our patients a fundamental principle I hold dear.The health care team was no more eager to address the issue than the family. I had produced specific state statutes regarding the health care directive of a previously competent person and even in light of this information, some individuals continued to believe the surrogates decision took precedence over the directive. This growing tension left me feeling angry and ineffective, questioning my role in the organization, while watching A. J. linger in a state not chosen. I believed I had failed... (shrink)

Knowledge work increasingly takes place in collaborative events from different and changing workplaces due to mobility, multi-locational, and geographical distribution of team members. What are the key elements to create mutual understanding and make creative collaborative decisions in global business meetings? How can these key elements be designed as shikake nudges to build awareness of the individual and team conditions to help knowledge workers make better work environment choices and reach higher levels of engagement? We addressed this question (...) as a transformative journey from island of knowledge to mutual understanding in the context of collaborative decision making in creative global business meetings. We present a “Six Steps to Engagement” framework that offers three feedback loops as shikake triggers to improve the local and global collaboration context and behavior, and three choice-decision-commitment steps toward improving the work environment and increasing knowledge work productivity. To support this framework, we define the following: (1) mutual understanding metrics (MUM) and method for self-assessment and 360 team assessment that define different MUM stages in the journey from island of knowledge to mutual understanding; and (2) an engagement Matrix of Choices (eMoC) prototype to assist geographically distributed knowledge workers to make explicit choices with an understanding of the potential level of engagement and collaboration they can achieve and the respective enablers and hindrances. We argue that iterative and continuous MUM assessment and explicit eMoC choices are central to achieve mutual understanding, high-performance teamwork, and eliminate rework, coordination, and decision wait time. This iterative process (1) allows team members to build awareness of their local conditions and make their local conditions transparent and visible to the rest of the team; (2) provides a feedback mechanism that indicates the engagement potential of each team member and the team, as well as a trigger or nudge toward moving to higher levels of engagement; (3) leads to the alignment of expectations and synchronicity of potential engagement levels. (shrink)

This theoretical development was carried out in response to the need of an interdisciplinary team of researchers of the complex concept of “social resilience of a person in a community”. An integration framework proposes to bring such efforts together. It includes aspects of the study of social resilience of a person in a community as a synergistic system, as one of the levels of a hierarchical system, as a problem-solving system.We consider synergistic social resilience as the subject’s ability to (...) go through shocks, which is enhanced by his capacity for self-learning and innovation. The authors analyzed the synergistic social resilience of a person in a community as a system of self-organization based on rhizome and network models. This also includes a person’s access to capital. At the same time, considering the system as synergistic reveals the probabilistic nature of its development. This does not rule out the possibility of developing the system’s stability by excluding its vulnerable members. The latter is an ethical dilemma.Hierarchy in social resilience is considered at the levels of interstate associations, states, individual branches of state functioning, territorial communities, individual social groups (professional groups, corporations or enterprises, public associations, religious communities, neighborhood communities, etc.), family, person. At the same time, we understand the completeness of the interdisciplinary study of the social stability of a person in the community through the management of the principle of “leaving no one behind” set by the Sustainable Development Goals.We also consider social resilience through a problem-solving orientation. This study proposes to focus on the fact that every person in his life can face a disaster to which he will not be able to adequately respond, based on the available internal resources, access to networks and capital. It can also apply to social groups, communities, and states. A possible solution in this case is an appeal from a more local to a more global level. Orientation to the solution of the problem opens the dialectic of hierarchical and synergistic aspects of social sustainability. It is as follows: an excess in the provision of solutions by the supersystem can become a detriment to the development of the local system, a lack of assistance can cause the death of the local system.Collectively, this forms an integrative framework for an interdisciplinary study of the social stability of a person in a community. Such a framework is designed to ensure the transformation of individual texts from various fields of scientific knowledge into a holistic multifaceted development that not only reveals concepts, but also opens up prospects for the development of social stability of a person in a community. (shrink)

Background: Clinical genomic implementation studies pose challenges for informed consent. Consent forms often include complex language and concepts, which can be a barrier to diverse enrollment, and these studies often blur traditional research-clinical boundaries. There is a move toward self-directed, web-based research enrollment, but more evidence is needed about how these enrollment approaches work in practice. In this study, we developed and evaluated a literacy-focused, web-based consent approach to support enrollment of diverse participants in an ongoing clinical genomic implementation study. (...) Methods: As part of the Cancer Health Assessments Reaching Many (CHARM) study, we developed a web-based consent approach that featured plain language, multimedia, and separate descriptions of clinical care and research activities. CHARM offered clinical exome sequencing to individuals at high risk of hereditary cancer. We interviewed CHARM participants about their reactions to the consent approach. We audio recorded, transcribed, and coded interviews using a deductively and inductively derived codebook. We reviewed coded excerpts as a team to identify overarching themes. Results: We conducted 32 interviews, including 12 (38%) in Spanish. Most (69%) enrolled without assistance from study staff, usually on a mobile phone. Those who completed enrollment in one day spent an average of 12 minutes on the consent portion. Interviewees found the information simple to read but comprehensive, were neutral to positive about the multimedia support, and identified increased access to testing in the study as the key difference from clinical care. Conclusions: This study showed that interviewees found our literacy-focused, web-based consent approach acceptable; did not distinguish the consent materials from other online study processes; and valued getting access to testing in the study. Overall, conducting empirical bioethics research in an ongoing clinical trial was useful to demonstrate the acceptability of our novel consent approach but posed practical challenges. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Operating Through HatredAndrew G. Shuman“You’re not cutting my ***ing neck. The cancer is in my ***ing mouth.”While many patient encounters are memorable, Mr. K’s introduction to the head and [End Page 20] neck surgical oncology clinic is indelibly imprinted into the minds of all of the clinicians present on that certain autumn morning. This was, quite simply, a man who resonated hate. He was rude and disruptive. He insisted (...) on an expedited workup “without any waiting.” He questioned the ethnicity and nationality of his care providers. He told me, in no uncertain terms, that he did not appreciate my Jewish heritage—the swastika tattooed on his bicep underscored the point. He bragged about his recent incarceration for armed robbery. While my colleagues and I were tempted to simply refuse to assume his care, Mr. K had a bad problem—his recurrent tongue cancer required a major operation in order to offer him any hope for cure.Mr. K initially received an abbreviated course of radiation at an outside institution, which was limited by his non–compliance. While one might debate the wisdom of this decision in retrospect—in general, surgery is preferred for his type of tumor—the die was already cast. A heroic attempt at surgical salvage was now his only curative option. He previously sought care elsewhere... only to be fired by this original surgeon when Mr. K physically threatened him in the outpatient office during preoperative consultation. [It was the doctor’s fault for insulting him in the first place, Mr. K maintained... and no charges were filed.] We were, indeed, his last resort. Other than his recurrent cancer, Mr. K was robust; he was in his sixth decade, physically fit, and on the whole, fairly healthy. In the classic surgical lexicon, he was a reasonable surgical candidate. But was it reasonable to operate on such a person?I remember thinking, at the time, about our obligation to care for such an individual. Of course, being a medical professional carries with it many obligations, including a judicious assumption of personal risk. And, working in a tertiary care center begets the responsibility to assist referring clinicians in the management of difficult cases. Although professional obligations certainly have their limits, defining their bounds is decidedly more difficult. Paramount is creating an atmosphere of mutual trust and acceptance. Naturally, this was easier said than done in regard to Mr. K.Perhaps against our better judgment, we agreed to operate under the condition that he abide by strict behavioral ground rules, on our terms. We agreed upon the extent of the necessary operation (which indeed involved cutting his ***ing neck, much to his chagrin and reluctant acceptance). Mr. K promised to follow instructions for postoperative care. He assured us that he would not swear or yell (again). And, in the presence of hospital security, who reinforced our institutional policies regarding patient behavior, he guaranteed that he would not be verbally or physically violent or inappropriate, and would not make disparaging comments to other patients or staff. It seemed, at least, that we had an understanding.Needless to say, these rules were broken shortly after he awoke from surgery. I vividly remember being summoned from the OR when he threatened to murder his impressionable and terrified nurse a few days later, who would not acquiesce to his unreasonable demands. From that point onward, hospital security was deployed to his room regularly, and anything resembling a potential weapon was safeguarded. Any semblance of a mutual doctor–patient bond was shattered. At this point, everyone’s goal was simply to get Mr. K home.My visceral reactions to his behavior, while intense, were not unexpected, and fell in line with those of the entire team of clinicians caring for him. His antics brought his healthcare team together in collective unity (and condemnation). However, my surgical colleagues and I also felt somewhat guilty and responsible. While surgeons can choose to assume some degree of inherent personal danger in caring for a violent and angry patient, we also put the safety and soundness of the entire perioperative team in jeopardy, without necessarily seeking their input. But once we had decided to... (shrink)

The Irish Teaching Council introduced a new model of school-based and National Induction Programme for Teachers (NIPT) called Droichead (meaning ‘bridge’ in Gaelic) in 2013/14. The Droichead process is an integrated professional induction framework for newly qualified teachers. It was designed to provide whole-school support for teacher induction in both primary and post-primary schools. This study explores the implementation of Droichead in a post-primary school, and to gain insights as to its effectiveness and the potential to bring about improvements. The (...) study found that NQTs are un-prepared to assume full teaching duties after initial teacher education (ITE), and can benefit greatly from having mentors from within the school to guide them through their first year of teaching. The benefits of the process include emotional support for NQTs, practical help in terms of learning new teaching strategies, the promotion of reflective practice and assisting the professional development of teachers. Droichead was found to promote peer observation and can help leaders change the culture of an organisation to better embrace and support peer observation and review. The programme also promoted and developed leadership skills among the mentors, who cited a renewed enthusiasm for teaching from their involvement in Droichead. There were conflicting views on the involvement of the senior leadership team in the programme, and it would seem that the success of their inclusion depends largely on the individual style of leadership. The negative aspects of the Droichead process related to the ‘Cluster meetings’ which are compulsory for NQTs and were seen as being too similar to their initial teacher education. (shrink)

John Wooden was arguably the greatest coach, the greatest leader, of all time. These Woodenisms, a collection of his wisdom and sayings, will inspire, motivate, and prepare you for any challenge you face. Woodensims provide good common sense, and will assist you in being a leader and a team player, and will also give you strength to carry on in whatever you do. Their pedigree, of course, is gold standard. Many of these Woodenisms have been distributed individually. They have (...) also been used in magazines and newspapers, and in presentations by Coach and other speakers. Now they are collected here, yours to cherish and enjoy as you strive for success in all areas of your life. (shrink)

These volumes conclude a series initiated in 1974, marking almost fifty years of effort by a huge cohort of scholars. This review is thus a valedictory for the whole series as well as an account of what we have learned from the most recent volumes about Darwin's final years (1879–82). The project was begun by Frederick Burckhardt, who shared the editorial role for the early volumes with Sydney Smith and a rolling sequence of assistant editors and advisers who eventually comprised (...) a significant fraction of the leading members of what used to be called the ‘Darwin industry’. Smith passed away in 1988 (volume 7 notes his legacy). Burkardt too left this world in 2007 – volume 16, part 1 includes an obituary, but his name has been retained and Cambridge University Press still ask that the series be cited as ‘Burkhardt et al.’ Duncan Porter took over for volumes 8–15, again with a sequence of fellow editors and assistants, after which James Secord became head of the project through its final years. The dedications of successive volumes record the efforts of individual scholars who have aided the teams and the involvement of the many institutions and foundations that have leant moral and material support over the years. For those of us with Cambridge connections, the University Library will not seem the same without the presence of the team it supported. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Dogs and MonstersObservations on the Evacuation of Afghanistan and the Intersection of Human Rights and the AnthropoceneK. M. Ferebee (bio)On August 28, 2021, former Royal Marine and charity worker Pen Farthing was evacuated from Afghanistan with almost two hundred dogs and cats that his Kabul animal charity, Nowzad Dogs, had rescued. The role of the British government in this evacuation remains hotly contested: At the time, the British Ministry (...) of Defence tweeted (Fig. 1) that Farthing's escape had been assisted by the British military, but Farthing later disputed this claim and argued that his rescue was not the result of high-level intervention in the British government. In January 2022 controversy erupted around the emergence of documents suggesting that Prime Minister Boris Johnson had lied to Parliament about the personal role that he played in just such an intervention. Notably, Nowzad's Afghan staff members were not evacuated alongside Farthing and the animals, though they would eventually escape to Pakistan. Following Farthing's escape, the British government failed to evacuate hundreds of British citizens and residents (Merriman and Ghouri), as well as many more Afghans who had worked on behalf of British forces. The Nowzad Dogs evacuation became a site of symbolic struggle over Britain's respect (or lack thereof) for human rights. "What a story to tell the world: Britain values dogs more than Afghan people," the headline of an opinion piece in the Guardian (Hinsliff) read.The story of Nowzad Dogs is interesting to me not only as a tale of human-nonhuman relations, but also because I was, at the time it occurred, volunteering within the Afghan aid community to assist relatives of a friend, British Afghans who had been visiting Kabul when the government [End Page 52] collapsed. The family repeatedly asked for assistance from the British Foreign, Commonwealth and Development Office—assistance that never appeared. Ultimately, due to the generosity of donors and the coordination of a volunteer team, the family was able to flee to Pakistan, where they boarded a commercial flight to London. This case was a particularly stark and powerful illustration of the negotiations of rights and value that took place during and following the evacuation. It seemed nonsensical, in August 2021, to suppose that British citizens, including British children (the family I worked with included a six- and an eleven-year-old who were British citizens), would be abandoned while Afghan dogs had their rights prioritized. As I hope to demonstrate here, however, such an incident becomes comprehensible and even logical when it is understood as part of a specifically Anthropocene manifestation of subjectivity.Upendra Baxi suggests that 1948's Universal Declaration of Human Rights (UDHR) marks a broad shift from the era of "modern" (42) human rights (which began with the American and French Revolutions) to the era of "contemporary" (42) human rights. His periodization links these eras in human rights to shifts in the ideology of capitalism and empire. The "modern" era of human rights, he writes, "signals a whole variety of ideological 'justifications' for colonization and world domination" and "provides a register of major development in industrial capitalism" (42), while the "contemporary" era of human rights "is based on the premise of radical self-determination" (46). Such a periodization also brings human rights into close alignment with the Anthropocene, which is rooted in the capitalist-colonial Enlightenment and Industrial Revolution, yet often dated most concretely to the circa-1950 shift that some (such as J. R. McNeill and Peter Engelke) label the "Great Acceleration." Indeed, one could reasonably appropriate Baxi's terms and speak of "modern" and "contemporary" Anthropocenes mapped identically onto the global timeline.I propose to use the 2021 Afghan evacuation as a site from which to explore how human rights and the Anthropocene have together coproduced certain forms of subjectivity that are essential for the continued smooth functioning of world-ecological capitalism. These new forms of subjectivity are necessary to sustain the important fiction of individual [End Page 53] agency and value and conceal the ways in which the Anthropocene moment renders this fiction meaningless. Ultimately, I paint a picture of an Anthropocene without any human agency at all. I want... (shrink)

Game theory is central to modern understandings of how people deal with problems of coordination and cooperation. Yet, ironically, it cannot give a straightforward explanation of some of the simplest forms of human coordination and cooperation--most famously, that people can use the apparently arbitrary features of "focal points" to solve coordination problems, and that people sometimes cooperate in "prisoner's dilemmas." Addressing a wide readership of economists, sociologists, psychologists, and philosophers, Michael Bacharach here proposes a revision of game theory that resolves (...) these long-standing problems. In the classical tradition of game theory, Bacharach models human beings as rational actors, but he revises the standard definition of rationality to incorporate two major new ideas. He enlarges the model of a game so that it includes the ways agents describe to themselves their decision problems. And he allows the possibility that people reason as members of groups, each taking herself to have reason to perform her component of the combination of actions that best achieves the group's common goal. Bacharach shows that certain tendencies for individuals to engage in team reasoning are consistent with recent findings in social psychology and evolutionary biology. As the culmination of Bacharach's long-standing program of pathbreaking work on the foundations of game theory, this book has been eagerly awaited. Following Bacharach's premature death, Natalie Gold and Robert Sugden edited the unfinished work and added two substantial chapters that allow the book to be read as a coherent whole. (shrink)

When faced with adverse circumstances, there may be a tendency for individuals, agencies, and governments to search for a target to assign blame. Our focus will be on the novel coronavirus outbreak, where racial groups, political parties, countries, and minorities have been blamed for spreading, producing or creating the virus. Blame—here defined as attributing causality, responsibility, intent, or foresight to someone/something for a fault or wrong—has already begun to damage modern society and medical practice in the context of the COVID-19 (...) outbreak. Evidence from past and current pandemics suggest that this tendency to seek blame affects international relations, promotes unwarranted devaluation of health professionals, and prompts a spike of racism and discrimination. By drawing on social and cognitive psychology theories, we provide a framework that helps to understand the effect of blame in pandemics, when people blame, whom they blame, and how blame detrimentally affects the COVID-19 response. Ultimately, we provide a path to inform health messaging to reduce blaming tendencies, based on social psychological principles for health communication. (shrink)

Orientation: This study investigated the influence of authentic leadership on employee flourishing while considering the potential mediating effect of trust in the organization and organizational support as underlying mechanisms in an uncertain setting.Research purpose: To examine the relationship between authentic leadership and employee flourishing by evaluating the indirect effect of organizational support and trust in the organization as potential mediators.Motivation for the study: An authentic leadership approach, organizational support, and trust in the organization may influence the flourishing of employees in (...) uncertain times. Increasing the comprehension of the possible interaction effect of organizational support and trust in the organization in the relationship between authentic leadership and employee flourishing may improve individual and organizational efficiency.Research approach/design and method: A quantitative, cross-sectional survey design was applied in this study. The sample comprised 314 employees in a noteworthy South African steel manufacturing entity. The Authentic Leadership Inventory, Workplace Trust Survey, Flourishing-at-Work Scale, and the Job Demands-Resources Scale were administered.Main findings: The findings of this study suggest that authentic leadership was a significant predictor of employee flourishing through organizational support and trust in the organization.Practical/managerial implications: This research illuminates the potential value-adding contribution of an authentic leadership style in promoting a trust-filled relationship between team members and their organization and the support they experience from their employer. Despite the prevailing precarious context, working under the mentioned conditions might result in the increased flourishing of employees.Contribution/value-add: The analyses of the mentioned relationships might assist businesses in optimizing the resources required to improve employee and organizational performance. Additionally, the exploration of organizational support in conjunction with organizational trust raises our understanding of the possible influence these elements can have in enhancing employee flourishing in the workplace. (shrink)

Background Decision-making competence is a complex concept in the care for transgender and gender diverse adolescents, since this type of care concerns one’s developing gender identity and involves treatment options that often lack international consensus. Even despite competence assessments, moral challenges arise in the decision-making process. Here, traditional forms of clinical ethics support such as moral case deliberation might not fit as these do not provide thematic guidance. This study therefore aimed to develop a practice-oriented ethics support tool to assist (...) care providers when dealing with moral challenges around decision-making competence in transgender adolescent care. Methods The study followed a participatory design to develop a tool in close collaboration with care providers; they had a say in all phases of development and dissemination. Firstly, nine care providers were interviewed about experienced moral challenges and needs for ethics support. Based on this, the structure and content of the tool was constructed and discussed in two focus group meetings, after which four care providers tested the tool and additional feedback was collected from the team and an advisory board. The final tool was presented to all Dutch care providers in transgender adolescent care. Results Care providers expressed a need for guidance in defining and assessing decision-making competence. Main moral challenges concerned discussing fertility options with young clients, dealing with co-occurring mental health difficulties and the decision-making role of parents. The final tool, named the Competence Consultant, is an interactive pdf containing four parts: (1) Clarify information; (2) Identify doubts and moral questions; (3) Guidance for conversations and (4) Overview and Conclusions. Discussion Developing an ethics support tool in a controversial care setting is highly relevant as it aims to help individual care providers in defining, discussing and dealing with their moral challenges in actual practice. The ‘Competence Consultant’ for transgender care providers contributes to their moral sensitivity and moral competence. It is an example of the development of innovative and integrative forms of thematic ethics support. (shrink)

Understanding a patient’s story is integral to providing ethically supportable and practical recommendations that can improve patient care. Important skills include how to elicit an individual’s story, how to weave different narrative threads together, and how to assist the care team, patients, and caregivers to resolve difficult decisions or moral dilemmas. Narrative approaches to ethics consultation deepen dialogue and stakeholders’ engagement to reveal important values, preferences, and beliefs that may prove critical in resolving care challenges. Recognizing barriers to narrative (...) inquiry, such as patients who are unable or refuse to share their story, is also important. In this article we offer specific steps and guidelines that ethicists can follow to systematically elicit and construct patients’ stories. We provide a case example to illustrate how a narrative approach to ethics consultation illuminates salient ethical issues that may otherwise go unnoticed. We argue that this approach should be part of every consultant’s tool kit. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Positive Change in Perception and Care for a Difficult PatientMelissa CavanaughIf you asked any healthcare professional if they had ever cared for a difficult patient, I am certain the answer would be a resounding "Yes!" I have encountered many over my forty-two years as an RN. The story of Ms. E. is one of exceptional challenge and, I hope, success.I met Ms. E. in 2012 when I took a (...) nursing position in an outpatient primary care Geriatric Clinic. The clinic was located within an inner city, Level 1 Trauma health system whose mission is to care for the underserved. This organization had cared for the most vulnerable in the area for decades. The clinic model is unique in that it provides a "one-stop shop" for the common medical needs of the older adult. Other specialties, including podiatry, rheumatology, dementia care, and stroke, held appointments in this clinic area. The supporting staff team members assisted in each of these clinics, leading them to interact with the same patients frequently.Most of my previous experiences had been in inpatient units with a quick turnover of patients. There was no time or need to develop a long-term relationship with the patients in these settings. However, the comprehensive services found in this clinic coupled with the low staff turnover, led to a stable group of seniors receiving care in this office. Many of these individuals had been attending this clinic for over twenty years.I heard about Ms. E. before I ever met her. She was well known to the clinic team as a "problem" patient. The general response when she was on the schedule was eye rolling and audible moans. I soon learned that in addition to her scheduled visits, she would randomly appear outside the full glass interior doors. She would hover in the area, tapping on the glass to get the attention of a staff member. She did not hesitate to interrupt staff and other patients to make her needs known when she was in the exam room hallway. Often team members would scatter and hide to avoid dealing with her. If she was not in the building, she was on the triage line with a question or physical complaint. To complicate matters even further, her husband was our patient as well, and they always attended appointments together.Ms. E. suffered from common geriatric chronic diseases such as hypertension, diabetes, and osteoarthritis. Her morbid obesity complicated her diagnoses. Though she was able to safely ambulate with an assistive device such as a cane or walker, she routinely used a motorized chair. She and her husband admitted visiting fast food restaurants often even though they had met with a dietician for counseling on several occasions. They often requested help obtaining medications, yet related stories about visiting the local casino. Ms. E. spoke with a small, weak voice that added to the countenance of helplessness and pity. Unfortunately, these behaviors of noncompliance, attention seeking, and dependency on others extended to her immediate community, and she is estranged from family and friends who may have been a source of support to her. [End Page E1]Ms. E.'s appointments were scheduled at the end of the day due to the expectation and pattern of the extended time they would take. No matter her expressed concerns or needs, our recommendations and interventions were never enough. She continually questioned the assessment information and did not want to accept the education and orders given as the correct response to her problems. As one can see, her appointments could be exhausting!Ms. E. certainly deserved the best and most comprehensive care available from our team. Developing a more therapeutic relationship for her within the clinic became a priority for me. However, it was a daunting task to provide this level of care and to convince her that she deserved and was receiving such care. She presented a laundry list of characteristics that could lead to biases from the staff. Overcoming such individual biases toward her may be a barrier as well. These included her obesity, her lack of initiative, her self-centered behaviors, and her constant need for attention.As healthcare professionals... (shrink)

Requests by patients or their families for treatment which the patient's physician considers to be "inappropriate" are becoming more frequent than refusals of treatment which the physician considers appropriate. Such requests are often based on the patient's religious beliefs about the attributes of God (sovereignty, omnipotence), the attributes of persons (sanctity of life), or the individual's personal relationship with God (communication, commands, etc). We present four such cases and discuss some of the basic religious tenets of the three Abrahamic faith (...) traditions as they relate to such requests. We suggest that religious reasons for requesting "inappropriate" treatment are "special" and deserve serious consideration. We offer guidance to assist clinicians and clinical ethicists as they attempt to resolve these conflicts, emphasising the importance of understanding the religious beliefs of the patient/surrogate and suggesting the assistance of a religious interpreter. We suggest open discussion with patients and families of both the clinical situation and the theological basis for these requests. We also suggest that clinicians use additional religious doctrines or principles from patients' own traditions to balance the reasons behind the requests. We conclude that most persistent requests for "inappropriate" treatment should be honoured. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:104 Feminist Studies 44, no. 1. © 2018 by Feminist Studies, Inc. Estelle Carol The Chicago Women’s Graphics Collective: A Memoir In 1973, the Chicago Women’s Graphics Collective worked in an old run-down second-floor office on Belmont Avenue, which we shared with the main offices of the Chicago Women’s Liberation Union (CWLU).1 They call it New Town now, but in 1973, there wasn’t much new about it. We weren’t (...) the only artists in the building though; downstairs was a tattoo parlor. Still, it was better than having the studio located in my apartment on Newport Street, where there were silkscreen tables in the dining room and a bathroom that doubled as a darkroom. My bedroom door opened directly into the dining room and usually reeked of the foul chemicals we used to make the posters. Just one OSHA inspection would have shut us down forever, but it was not until later that we learned about the dangers of long-term exposure. On Newport Street, the apartment was right next to the Ravenswood Branch of the “L,” and it shook like the aftershock of a California earthquake each time a train passed. But we were in the midst of a women’s revolution, and our priorities were clear. 1. The Chicago Women’s Graphics Collective (WGC) was a “workgroup” of the CWLU from the very start. There were about 25 workgroups and other groups within the CWLU. CWLU outreach to recruit new members got a lot of new women into WGC. WGC, Women’s Liberation Rock Band, and Womankind Newspaper were the cultural arms of the CWLU. Cultural outreach to attract new CWLU members and new feminists to the movement in general was critical to the CWLU’s success. In Celebration of Amazons, 194. All posters designed and silkscreened collectively by the Chicago Women’s Liberation Union, www.cwluherstory.org. Courtesy of CWLU Herstory Project. All posters are on silkscreen. Turning Through Time, Workwoven, 195. Sisterhood Is Blooming, Springtime Will Never Be the Same, 190. Chicago Women’s Labor History, 194. International Women’s Day (reprinted from a Cuban poster). ABOVE Healthcare Is for People, Not for Profit, 195. OPPOSITE Abortion Is a Personal Decision, Not a Legal Debate, 190. ABOVE Healthcare Is for People, Not for Profit, 195. OPPOSITE Abortion Is a Personal Decision, Not a Legal Debate, 190. OPPOSITE Chicago Maternity Center, 192. ABOVE Lesbian Pride, 192. Mountain-Moving Day, 192. ABOVE Detail from Mountain-Moving Day, 192. OPPOSITE Women Unite, Take Back the Night, 199. Lipstick and Blood (reprinted from a Cuban design). Women Are Not Chicks, 191. Liberation School for Women, 192. Boycott Red Coach Lettuce, 192. Working Women Unite, 195. International Women’s Day, Many Waves But One Ocean, 192. Estelle Carol 121 If you look at Chicago Women’s Graphics Collective posters, you’ll rarely see a person’s name on them, because we decided early on that art had been done all wrong by men. It was based on egotism and the cult of the individual—the great-men-of-art syndrome. So we decided to throw all that out, and art now had to be a collective experience. So every poster that we created had to be done by committee. Every one. We had a system in which any one of the collective could get an idea or a phrase or an image and decide to do a poster. They would ask two or three other members to be their assistants and to help develop the idea. And then in little teams they would physically create the poster in silk screen. It had to be a collective process. There’s no way that one single woman could really do it because we were using very primitive reproduction methods, and we needed at least three people to run the silk screen. The silk screens were all hand printed. No machines. If a poster was more than one color, it had to be hand printed, one color at a time, so it was very, very labor intensive. And... (shrink)

The construct of “choking under pressure” is concerned with the phenomenon of unexpected, sudden, and significant declines in individual athletes’ performances in important situations and has received empirical attention in the field of sport psychology. Although a number of theories about the reasons for the occurrence of choking under pressure exist and several intervention approaches have been developed, underlying mechanisms of choking are still under debate and the effectiveness of existing interventions remains contested. These sudden performance declines also occur in (...) team sport. “Collective sport team collapse,” which describes the situation when an entire sport team underperforms significantly within an important competitive situation, has received less empirical attention, in comparison to individual choking research. While there are a few studies that have investigated causes of collective team collapse, understandably, there has been limited empirical investigation of preventative and intervention strategies. Although the two constructs appear to share several similar characteristics and mechanisms, research has not yet examined the conceptual, theoretical, empirical, and practical links between choking under pressure and collective sport team collapse. In this review article, we seek to examine these similarities and differences and identify new ways of thinking about future interventions. Furthermore, current empirical understandings in the field of choking under pressure and collective sport team collapse are presented and the most effective intervention approaches for both constructs are introduced. On the basis of this examination, we modestly make some initial recommendations for sport psychological practitioners and future research. (shrink)

This is a revision of game theory which takes account of agents' own descriptions of their situations, and which allows people to reason as members of groups.

Coping with stress has been primarily investigated as an individual-level phenomenon. In work settings, however, an individual’s exposure to demands is often shared with co-workers, and the process of dealing with these demands takes place in the interaction with them. Coping, therefore, may be conceptualized as a multilevel construct. This paper introduces the team coping concept and shows that including coping as a higher-level team property may help explain individual-level outcomes. Specifically, we investigated the effects of exposure to (...) danger during deployment on burnout symptoms in military service members and examined to what extent this relationship was moderated by individual-level and team-level functional coping. We hypothesized that the relationship between individuals’ exposure to danger and burnout is contingent on both. In line with our predictions, we found that service members who were highly exposed to danger, and did not engage in much functional coping, suffered most from burnout symptoms, but only when their teammates did not engage in much functional coping either. When their teammates did engage in much functional coping, the effect of exposure to danger on burnout was buffered. Hence, team members’ coping efforts functioned as a resilience resource for these service members. (shrink)

In this paper, we derive necessary and sufficient conditions on team based tasks in order for a selection criterion applied to individuals to produce optimal teams. We assume only that individuals have types and that a team’s performance depends on its size and the type composition of its members. We first derive the selection principle which states that if a selection criterion exists, it must rank types by homogeneous team performance, the performance of a team consisting (...) only of that type. We then prove that a selection criterion exists if and only if replacing the team’s lowest ranked type, as measured by homogeneous team performance, with a higher ranked type increases team performance. Finally, we show that the replace the lowest ranked property rules out most common types of team complementarities, including benefits to diverse types and types that fill structural holes. (shrink)

This paper examined the persistence of individuals’ power in teams and the individual- and team-level factors influencing power maintenance and loss in the long-term. Specifically, and in line with the functional theory of power, we showed that individuals’ state of power in the past exerted a significant behavioral impact on their later state of power, hence, confirming the “power persistence” hypothesis. Furthermore, and in accordance with the conflict theory of power, we found that individuals’ competence positively influenced power above (...) and beyond its persistence. We also showed that individuals’ uncooperative behavior and team performance had a negative and significant effect on individuals’ power above and beyond its persistence. Finally, we discussed the importance of individuals’ power dynamics for effectively managing power struggles in teams. (shrink)

In this chapter, we explore the issue of assisted dying for individuals with dementia at the nexus of ethics and law. We set out the basic medical realities of dementia and the available data about the desire for the option of assisted dying in the face of dementia. We then describe law and practice with respect to voluntary euthanasia and assisted suicide in jurisdictions that permit at least some assisted dying. We conclude that, because of the (...) peculiar ways in which some of the features of dementia interact with specific legislative provisions, less access to assisted dying for persons with dementia can be realized through the legislation than might have been intended or expected. We then describe draft assisted dying legislation that is before the federal Parliament of Canada. We conclude that, because of the peculiar ways in which some of the features of dementia interact with specific legislative provisions, more access to assisted dying for persons with dementia would be realized, if the legislation was passed as drafted, than might be intended or expected. This exercise reveals that very careful attention needs to be paid to the features of dementia if drafting assisted dying legislation in order to actually achieve the desired law reform effect (whatever that might be). The interplay of common ethical rationales for permitting assisted dying (e.g., autonomy and alleviation of suffering) with common features of dementia (e.g., loss of competence before the terminal phase of the illness, loss of the capacity to communicate before the loss of the capacity to suffer) raises challenges for translating one’s ethical position on assisted dying for individuals with dementia into law. NB: This chapter is current up to 2015. (shrink)

Teamwork has been argued to play an increasingly important role in numerous jobs, and several studies focused on the effects of team composition for work-related outcomes. Recent research has also identified individuals’ character strengths and positive team roles as conducive to work-related outcomes. However, there is a scarcity of research on the role of character strengths or positive team roles on the level of teams. In the present study, we extend theoretical assumptions of team role theories (...) to the study of character strengths and positive team roles: We examined the associations between character strengths and team roles with work-related outcomes on the individual and the team level. Further, we examined how the team composition relates to the outcomes, that is, whether balanced teams go along with desired outcomes and whether an overrepresentation of team roles or character strengths in a team goes along with undesired outcomes. We studied a sample of 42 teams who completed measures of team roles, character strengths, teamwork quality, job satisfaction, and self-rated individual and team performance. Further, supervisor ratings of individual and team performance were collected. Results corroborated the relationships of team roles and character strengths with individual outcomes such as that specific roles and character strengths go along with individual performance and work satisfaction. Further, the results suggested that teams in which more team roles are represented report higher performance and teamwork quality. Also, teams with higher average levels of the character strengths of teamwork and fairness, and teams with more members scoring high in fairness and prudence report higher teamwork quality. Further, there is no evidence that having too many members with a particular character strength has detrimental effects on teamwork quality, work satisfaction, or performance. We conclude that extending the study of character to the level of teams offers an important advancement. (shrink)

The college assistant team is the core power to develop college students’ ideological and political education, and it is the organizer, executor, and instructor of the college students’ daily ideological and political education and management, and its cohesive power will directly determine the construction and the function of the assistant team. As the management department of the college assistant team, colleges should adopt relative measures which will be discussed in this article to strengthen the cohesive power of (...) the assistant team, and fully exert the education and instruction function of the assistant team, and make contributions for cultivating qualified talents. (shrink)

Physical activity, specifically exercising, has been suggested to improve body image, mental health, and well-being. With respect to body image, previous findings highlight a general benefit of exercise. This study investigates whether the relationship between exercising and body image varies with the type of exercise that individuals preferentially and regularly engage in. In addition, physical efficacy was explored as a potential psychological mediator between type of exercise and body image. Using a cross-sectional design, healthy regular exercise practitioners of yoga, ballroom (...) dance, team sports, or individual sports as well as healthy adults reporting no regular exercising were surveyed. Body image and its different facets were assessed by a set of standardized self-report questionnaires, covering perceptual, cognitive, and affective body image dimensions particularly related to negative body image. In addition, participants were questioned with regard to mental health. Participants were 270 healthy adults. Descriptive statistics, measures of variance, and multiple linear regression analysis with orthogonal contrasts were performed to investigate differences between the different exercise and non-exercise groups in the variables of interest. In line with the hypotheses and previous findings, the statistic comparisons revealed that body dissatisfaction was most pronounced in the non-exercise group compared to all exercise groups [contrast: no exercise versus exercise ]. Physical efficacy, as assessed with a standardized questionnaire, mediated the difference between type of exercise and body image including perceptual, cognitive, and affective body image dimensions. The findings shed light on so far less systematically investigated questions regarding the relationship between types of exercise, like yoga and ballroom dance, and body image. The results underscore the relevance of considering possible influencing factors in exercise research, such as the perception of one’s physical efficacy as a mediator of this relationship. (shrink)

There are hardly any instruments to measure teamwork behaviors from an individual approach. This applies both in interprofessional teams or not, and in teams involved in health, social care, and other areas. The Individual Behavior Analysis scale measures efficacious behavior in work teams. It is one of the few instruments proposed in the literature to measure personal skills necessary for teamwork. Only a previous exploratory analysis of the scale was informed in another study. This article analyzes its internal structure using (...) different confirmatory factor analyses and its internal consistency, with a sample of 815 employees working for Spanish social organizations in the geriatric field, both private and public. The results of the definitive version adapted to Spanish, referred to as Individual Behavior Analysis −25, indicate a good fit of the model to the data and good reliability. Factor analysis confirmed the existence of two factors: Communication skills and Acceptance, with good internal consistency coefficients. This scale is a useful instrument for assessing, based on the reviewed literature, two of the most important individual skills an efficacious team should have. (shrink)