Dysfunctional customer behavior is common in service settings. For frontline employees, negative encounters can cause short-term despondency or have profound, long-term psychological effects that often result in both direct and indirect costs to service firms. Existing research has explored the influence of dysfunctional customer behavior on employee emotions, but it has not fully investigated the psychological mechanism through which customer misbehavior transforms into employee responses. To maintain service quality and employee well-being, it is important to understand the impact of (...) customer misconduct on employee emotions and its effect on subsequent service behavior. To assess the process through which dysfunctional customer behavior manifests as negative emotions in frontline service employees, and the influence of negative employee emotions on their prosocial service behavior, we surveyed 185 frontline banking service employees. We sought information on service employee experiences, attitudes, and feelings regarding dysfunctional customer behaviors, the perceived level of supervisor support, and employee prosocial service behavior intentions. Structural equation modeling and hierarchical linear modeling were used for statistical analysis and hypothesis verification. Results indicate that dysfunctional customer behavior has a positive relationship with bank service employee negative emotions and a negative influence on employee prosocial service behavior. The study found that negative emotions fully mediated the relationship between dysfunctional customer behavior and prosocial service behavior. The moderating role that perceived supervisor support plays on the relationships between dysfunctional customer behavior and negative emotion was also investigated. The results show that perceived supervisor support moderates the relationship between dysfunctional customer behavior and negative employee emotions. Finally, the study provides bank managers with effective strategies to assist frontline employees to manage and deter dysfunctional customer behavior, and presents employees with internal recovery strategies when encountering dysfunctional customer behavior. (shrink)

BackgroundThe pandemic of Coronavirus Disease 2019 has burdened an unprecedented psychological stress on the front-line medical staff, who are at high risk of depression. While existing studies and theories suggest that factors such as gratitude, social support, and hope play a role in the risk of depression, few studies have combined these factors to explore the relationship between them.ObjectiveThis study examined the mediating roles of social support and hope in the relationship between gratitude and depression among front-line (...) medical staff during the pandemic of COVID-19.MethodsThis study used the Gratitude Questionnaire, the Perceived Social Support Scale, the State Hope Scale, and the Center for Epidemiologic Studies Depression Scale to examine the gratitude, social support, hope, and depression among 344 front-line medical workers in Wuhan, which was the hardest-hit area of COVID-19 in China.ResultsThe results showed that the prevalence of mild depressive disorder was 40.12% and the prevalence of major depressive disorder was 9.59% among front-line medical staff during the pandemic of COVID-19; gratitude has a direct and negative effect on depression. Gratitude was negative predictors of depression through the mediating variables of social support and hope [βgratitude–social support–depression = −0.096, 95%CI; βgratitude–hope–depression = −0.034, 95%CI], as well as via an indirect path from social support to hope [βgratitude–social support–hope–depression = −0.089, 95%CI ].ConclusionThe study findings indicate that gratitude as a positive emotion can reduce depression in medical staff by promoting social support and hope, respectively. Gratitude also reduced depression in health care workers through a chain mediating effect of social support and hope. Overall, gratitude can directly foster social support and hope, and protect people from stress and depression, which has implications for clinical interventions among front-line medical staff during the pandemic of COVID-19. (shrink)

The remote working environment is characterised by excessive use of new technology and work activities that extend to personal time. It is expected of each employee to balance multiple roles whilst maintaining maximum performance and individual wellbeing; however, without adequate support from an organisation, employees languish instead of flourish. The current study applied a model to investigate the combined effect of technostress, work–family conflict, and perceived organisational support on workplace flourishing for higher education employees. The study followed a (...) cross-sectional quantitative research framework. Data were collected from a sample of 227 academic and support staff employees from a selected residential University in South Africa. The results indicated that technostress through perceived organisational support and through work–family conflict influences workplace flourishing. No direct significant effect was reported between technostress and workplace flourishing. Technostress, work–family conflict, and perceived organisational support combined explained 47% variance in workplace flourishing. Perceived organisational support displayed the strongest direct effect on workplace flourishing, and technostress is a strong determinant of work–family conflict, which then mediates the relationship between technostress and workplace flourishing. The study concluded that providing organisational support and creating policies favourable to work–life balance assist employees in managing techno-overload, techno-invasion, and techno-complexity better and enhance workplace flourishing. Although employees struggle in the remote working context with demands imposed by techno-overload, techno-invasion, and techno-complexity, the results indicate that perceived organisational support and balanced work life act as job resources that enhance emotional, psychological, and subjective wellbeing. (shrink)

Being a healthcare professional in both paediatric and adult hospitals will mean being exposed to human tragedies and stressful events involving conflict, misunderstanding, and moral distress. There are a number of different structured approaches to reflection and discussion designed to support healthcare professionals process and make sense of their feelings and experiences and to mitigate against direct and vicarious trauma. In this paper, we draw from our experience in a large children’s hospital and more broadly from the literature (...) to identify and analyse four established approaches to facilitated reflective discussions. Each of the four approaches seeks to acknowledge the stressful nature of health professional work and to support clinicians from all healthcare professions to develop sustainable skills so they continue to grow and thrive as health professionals. Each approach also has the potential to open up feelings of uncertainty, frustration, sorrow, anguish, and moral distress for participants. We argue, therefore, that in order to avoid unintentionally causing harm, a facilitator should have specific skills required to safely lead the discussion and be able to explain the nature, scope, safe application, and limits of each approach. With reference to a hypothetical but realistic clinical case scenario, we discuss the application and key features of each approach, including the goals, underpinning theory, and methods of facilitation. (shrink)

Research has indicated that 13% of students in the UK experience a high degree of assessment‐related stress/anxiety, which may have debilitating health, emotional and educational effects. Recent policy initiatives have attempted to encourage a responsibility for promoting well‐being in schools; however, at present there is little known about what, if any, support is provided for students over assessment stress/anxiety. The purpose of this exploratory study was to gather data on the conceptualisation and understanding of assessment stress/anxiety in key stage (...) 4 students, and what current policy and practice are adopted to support students experiencing a high degree of assessment stress/anxiety. Data were collected from semi‐structured interviews conducted with 34 students and nine members of staff from six schools in the north of England and analysed using an abbreviated form of grounded theory according to the principles, as described by Strauss and Corbin. Teachers conceptualised assessment stress/anxiety as resulting from KS4 assessment demands requiring skills and knowledge beyond the current capabilities of students. Support was mostly structured along academic lines, theorised as reducing stress by increasing the students’ ability to cope with assessment demands. Students who experienced a strong degree of manifest anxiety during examinations were moved to alternative venues, but students were not routinely identified in all schools prior to their final GCSE examinations. Staff and students also emphasised the importance of a “good” relationship in receiving both emotional and academic forms of support. These strategies were theorised as “bolt‐on” policies. Schools had few specific strategies for dealing with assessment stress/anxiety directly but used existing policies related to behaviour management and the promotion of achievement. (shrink)

Joan Tronto defines care by three activities: maintaining, continuing, and repairing. These activities give care a maintenance quality, which is problematic given that caring often takes place within contexts of inequality and domination. Empirical research with paid support staff and people with intellectual and developmental disabilities (IDD) illustrate these problems: care practices tend to reinforce the social exclusion of people with IDD, particularly for people with challenging behavior. Yet, support workers’ care practices can facilitate a better quality (...) of life for people with IDD. This improved style of support maps onto Tronto’s fifth phase of care, caring with, which hinges practices of care on democratic principles of justice, equality, and freedom. As such, democratic care requires activities that Tronto excludes from care, including creativity, disruption, and pleasure. I use empirical research from the field of IDD to show how support workers and people with IDD practice creative, disruptive, and playful care to challenge persistent forms of exclusion, inequality, and stigma. (shrink)

A contemporary orientation of the hospital experience model must encompass the clients’ religious-spiritual dimension. The objective of this paper is to share a previous experience, highlighting at least five reasons hospitals should invest in this direction, and an equal number of steps required to achieve it. In the first part, the text discourses about five reasons to invest in religious-spiritual support programs: 1. Religious-spiritual wellbeing is related to better health; 2. Religious-spiritual appreciation is a standard for hospital accreditation; 3. (...) To undo religious-spiritual misunderstandings that can affect treatment; 4. Patients demand a religious-spiritual outlook from the institution; and 5. Costs may be reduced with religious-spiritual support. In the second part, the text suggests five steps to implement religious-spiritual support programs: 1. Deep institutional involvement; 2. Formal staff training; 3. Infrastructure and resources; 4. Adjustment of institutional politics; and 5. Agreement with religious-spiritual leaders. The authors hope the information compiled here can inspire hospitals to adopt actions toward optimization of the healing experience. (shrink)

In Japan, most residents with Hansen’s disease live in dedicated sanatoria because of an established quarantine policy, even after being cured of the primary disease. They suffer from secondary diseases and are advancing in age, and advance care planning is increasingly crucial for them to live their lives with dignity in a sanatorium. In this study, we have three aims: to understand how to promote communication about their wishes for medical treatment, care, and recuperation; to identify required assistance; and to (...) explore how to promote ACP in a sanatorium. This study is a qualitative research conducted through semi-structured interviews. The study included 57 ex-Hansen’s disease patients and 66 staff from 10 facilities. Ex-Hansen’s disease patients were expected to consider ACP, but this was in the context of uncertainty about whether a sanatorium would close and whether there would be doctors to manage their needs. They reported being confused when staff rushed to confirm their advance directives, feeling that they were not provided with enough information before being approached. Barriers to promoting ACP were found to be insufficient of team-based care and information sharing, ex-Hansen’s disease patients’ weak interest in their end of life, and their conservative thoughts. We believe that ACP can be achieved by listening to the wishes of recovered patients through regular home care visits by nurses and everyday support by care workers. Furthermore, multidisciplinary coordination is urgently needed for promoting ACP. (shrink)

Background The COVID-19 pandemic causes moral challenges and moral distress for healthcare professionals and, due to an increased work load, reduces time and opportunities for clinical ethics support services. Nevertheless, healthcare professionals could also identify essential elements to maintain or change in the future, as moral distress and moral challenges can indicate opportunities to strengthen moral resilience of healthcare professionals and organisations. This study describes 1) the experienced moral distress, challenges and ethical climate concerning end-of-life care of Intensive Care (...) Unit staff during the first wave of the COVID-19 pandemic and 2) their positive experiences and lessons learned, which function as directions for future forms of ethics support. Methods A cross-sectional survey combining quantitative and qualitative elements was sent to all healthcare professionals who worked at the Intensive Care Unit of the Amsterdam UMC - Location AMC during the first wave of the COVID-19 pandemic. The survey consisted of 36 items about moral distress (concerning quality of care and emotional stress), team cooperation, ethical climate and (ways of dealing with) end-of-life decisions, and two open questions about positive experiences and suggestions for work improvement. Results All 178 respondents (response rate: 25–32%) showed signs of moral distress, and experienced moral dilemmas in end-of-life decisions, whereas they experienced a relatively positive ethical climate. Nurses scored significantly higher than physicians on most items. Positive experiences were mostly related to ‘team cooperation’, ‘team solidarity’ and ‘work ethic’. Lessons learned were mostly related to ‘quality of care’ and ‘professional qualities’. Conclusions Despite the crisis, positive experiences related to ethical climate, team members and overall work ethic were reported by Intensive Care Unit staff and quality and organisation of care lessons were learned. Ethics support services can be tailored to reflect on morally challenging situations, restore moral resilience, create space for self-care and strengthen team spirit. This can improve healthcare professionals’ dealing of inherent moral challenges and moral distress in order to strengthen both individual and organisational moral resilience. Trial registration The trial was registered on The Netherlands Trial Register, number NL9177. (shrink)

Children and adolescents with an intellectual disability and autistic traits often attend special needs schools where they are surrounded by peers with diverse characteristics. Given the role that peers can play in social development, we examined whether autistic traits development in students with ID and high levels of such characteristics are influenced by the level of autistic traits among the schoolmates they like most. Furthermore, we investigated the degree to which this peer influence susceptibility depends on students’ gender. A longitudinal (...) design, with data collection points at the beginning and the end of a school year, was used. Staff reported on 330 students with high levels of autistic traits who attended 142 classrooms in 16 Swiss special needs schools. Results showed that students’ future individual level of autistic traits was not predicted by the autistic traits level of preferred peers, controlling for individual autistic traits at T1, level of general functioning, gender, and age. However, the peer effect was significantly moderated by students’ gender, indicating that girls but not boys were susceptible to peer influence. These findings are discussed in terms of implications for understanding autistic traits development and directions of support for children and adolescents in their peer context. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Future Directions for Human Cloning by Embryo Splitting:After the HullabalooCynthia B. Cohen (bio)In October 1993, a paper entitled, "Experimental Cloning of Human Polyploid Embryos Using an Artificial Zona Pellucida," was presented at a joint meeting of the American Fertility Society and the Canadian Fertility and Andrology Society. Although it was awarded a prize, its authors, who are affiliated with George Washington University, decided against calling a press conference to (...) announce their findings. Word of their experiment soon leaked out, however, and the New York Times blazoned on its front page that human embryo cloning had been achieved. The story was accompanied by a diagram of cloning by nuclear transplantation.Newspapers and television networks around the world picked up the story and embellished it. The idea of unlimited, xeroxed copies of human beings gripped the public imagination. Wild scenarios of hundreds of Hitlers plotting to take over the world and of clones giving birth to their own twins enlivened media reports. Only gradually did it become clear that the term "polyploid" in the title of the paper referred to abnormal embryos that could never develop into living human beings and that "cloning" referred to embryo splitting or twinning, not to nuclear transplantation or the transfer of a donor nucleus into an enucleated egg. Once this sank into public consciousness, the "hullabaloo," as Dr. Howard W Jones, Jr., called it, died down.It left in its wake unanswered questions about the ethics of splitting embryos. During the height of the publicity given to the George Washington experiment, newspaper and TV stories had not delved in any depth into the ethical issues it raised. Ethicists, given limited time to discuss the ethical questions at stake, had been quoted in quick, simplistic responses. Some had offered little analysis of the rights and wrongs of embryo splitting, but, revealing tremendous creative talent, had spun out [End Page 187] imaginary and frightening applications of the procedure. This was a story essentially about ethics in which ethics was never really discussed.The National Advisory Board on Ethics in Reproduction* (NABER), an independent, multidisciplinary group that addresses ethical issues in modern reproductive science, technology, and care, became concerned about the sparsity of reflective ethical debate about embryo splitting. NABER's chair, Albert Jonsen, observed that "reporters phoning ethicists for comment and ethicists appearing on talk shows do not a debate make. Debate requires face to face (or at least essay to essay) argument among persons sharing the same information. This has yet to take place." Consequently, NABER decided to convene a workshop on human cloning by embryo splitting at the National Academy of Sciences in February 1994. The board invited participants who would provide a broad range of opinion about the ethical and public policy issues entailed by human embryo splitting. Embryologists, ethicists, reproductive biologists, public policy experts, staff from the National Institutes of Health (NIH), legal scholars, journalists, and infertility specialists were among those who participated. The feature articles in this issue of the Kennedy Institute of Ethics Journal derive from that workshop. Their authors were given free rein to take whatever stance they deemed ethically supportable.The first article is designed to provide some understanding of the science of human cloning as a basis for exploring the ethical issues raised by this set of techniques. Jacques Cohen, a leading reproductive embryologist, and Giles Tomkin, a science writer, both of Cornell University Medical School, explain, in a way that is clear to laypersons and biologists alike, the meaning, nature, and function of cloning. They discuss recent: advances in this area and offer an assessment of feasible uses of human cloning procedures, hoping to dispel what they view as mistaken fears about its future applications. Dr. Howard W Jones, Jr., a pioneer infertility specialist, briefly comments on Cohen and Tomkin's paper, pointing out that embryo splitting may not improve pregnancy results if genetic heterogeneity is required for successful embryo transfer and implantation.In the next article, three major ethical arguments against human cloning by embryo splitting are analyzed and rejected by Ruth Macklin, an expert in reproductive ethics from Albert Einstein College of Medicine. She finds the first argument, that the worth of individuals... (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 (e.g. conversations, advance directives), 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 (e.g. social workers, physical therapists) completed a survey. Ethical considerations The study was approved by the University Hospital of Brussels (B.U.N. 143201834759), as part of a cluster randomized controlled trial (clinicaltrials.gov NCT03521206). Results One hundred ninety-six nurses, 319 care assistants and 169 allied staff participated (67% response rate). After adjusting for confounders, nurses were significantly more likely than care assistants to have carried out advance care planning conversations (odds ratio 4; 95% confidence interval 1.73–9.82; p < 0.001) and documented advance care planning (odds ratio 2.67; 95% confidence interval 1.29–5.56; p < 0.001); differences not found between allied staff and care assistants. Advance care planning knowledge total scores differed significantly, with nurses (estimated mean difference 0.13 (score range 0–1); 95% confidence interval 0.08–0.17; p < 0.001) and allied staff (estimated mean difference 0.07; 95% confidence interval 0.03–0.12; p < 0.001) 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)

Public research organizations respond to external pressures from national research evaluation systems, performance-based funding systems and university rankings by translating them into internal goals, rules and regulations and by developing organizational identities, profiles and missions. Organizational responses have primarily been studied at the central organizational level, and research on the steering of research has primarily focused on the impacts of performance-based funding systems. However, research evaluation exercises may also have a formative impact, especially below the central organizational level. This paper (...) uses a case study of a research unit of a biomedical research school in the Netherlands to explore the organizational response to a relatively critical external assessment report. It shows that the participation in the Dutch research evaluation cycle legitimated the formation of a new organizational identity for the research unit, which functions as a frame that suggests to staff members a new interpretation of the type of research that is at the core of what the research unit does. We identify three additional steering mechanisms that support the enactment of the organizational identity: steering by resource allocation, by suggesting and by re-organizing. We, furthermore, explore the epistemic effects – the direction and conduct of research – of the organizational response, through interview data in combination with a bibliometric analysis. (shrink)

Purpose The escalating integration of AI tools like ChatGPT within academia poses a critical challenge regarding their impact on faculty members’ and researchers’ academic performance levels. This paper aims to delve into academic performance within the context of the ChatGPT era by exploring the influence of several pivotal predictors, such as academic integrity, academic competence, personal best goals and perceived stress, as well as the moderating effect of ChatGPT adoption on academic performance. Design/methodology/approach This study uses a quantitative method to (...) investigate the impact of essential variables on academic integrity, academic competence, perceived stress and personal best goals by analysing 402 responses gathered from ResearchGate and Academia.edu sites. Findings While affirming the established direct positive relationship between academic integrity and performance since adopting AI tools, this research revealed a significant moderating role of ChatGPT adoption on this relationship. Additionally, the authors shed light on the positive relationship between academic competence and performance in the ChatGPT era and the ChatGPT adoption-moderated interaction of competence and performance. Surprisingly, a negative association emerges between personal best goals and academic performance within ChatGPT-assisted environments. Notably, the study underscores a significant relationship between heightened performance through ChatGPT and increased perceived stress among academicians. Practical implications The research advocates formulating clear ethical guidelines, robust support mechanisms and stress-management interventions to maintain academic integrity, enhance competence and prioritise academic professionals’ well-being in navigating the integration of AI tools in modern academia. Originality/value This research stands out for its timeliness and the apparent gaps in current literature. There is notably little research on the use of ChatGPT in academic settings, making this investigation among the first to delve into how faculty and researchers in education use OpenAI. (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)

Criticising someone’s conduct is a disaffiliative action that can attract recipient objections, particularly in the form of defensive detailing by which the recipient volunteers extenuating circumstances that undermine the criticism. In Therapeutic Community meetings for clients with drug addiction, support staff regularly criticise clients’ behaviours that violate therapeutic principles or norms of conduct. This study examines cases where, rather than criticising a client’s behaviour directly, TC staff members do so indirectly through an anecdote: a case illustrating the (...) inappropriateness of the type of conduct of which the client’s behaviour is an instantiation. TC staff members design the anecdote to convey a principle or norm of conduct which the client has putatively violated, and they systematically pursue endorsement of that principle by the client. By constructing the anecdote as an exemplary case, distanced from the individual client’s personal experience, TC staff members make it an empirically unverifiable, self-evident, and therefore hard to challenge, illustration of a norm. (shrink)

ObjectiveParenting sensitivity and mutual parent-child attunement are key features of environments that support children’s learning and development. To-date, observational measures of these constructs have focused on children aged 2–6 years and are less relevant to the more sophisticated developmental skills of children aged 7–8 years, despite parenting being equally important at these ages. We undertook a rigorous process to adapt an existing observational measure for 7–8-year-old children and their parents. This paper aimed to: describe a protocol for adapting an (...) existing framework for rating parent-child interactions, determine variations in parents’ sensitive responding and parent-child mutual attunement by family demographics, and evaluate the psychometric properties of the newly developed measure.MethodParent-child dyads completed one home visit, including a free-play observation and parent questionnaire. Dyads were provided with three toy sets: LEGO® Classic Box, Classic Jenga®, and animal cards. The Coding of Attachment-Related Parenting was adapted for use with 7–8-year-old children, and rating procedures were streamlined for reliable use by non-clinician/student raters, producing the SCARP:7–8 Years. Trained staff rated video-recorded observations on 11 behaviors across two domains.ResultsData were available for 596 dyads. Consistently strong inter-rater agreement on the 11 observed behaviors was achieved across the 10-week rating period. Average ICCs were 0.77 for sensitive responding and 0.84 for positive mutuality. These domains were found to be related but distinct constructs. For both domains, average ratings were strongly associated with the main toy used during the observation. Adjusted multivariate linear regression models revealed that less sensitive responding was associated with younger parent, male parent, non-English speaking background, and greater neighborhood disadvantage. Construct validity was demonstrated using six parent-reported psychosocial and parenting measures.ConclusionThe SCARP: 7–8 Years shows promise as a reliable and valid measure of parent-child interaction in the early school years. Toy selection for direct observation should be considered carefully in research and practice settings. (shrink)

Guilt and shame are self-conscious emotions with implications for mental health, social and occupational functioning, and the effectiveness of sports practice. To date, the assessment and role of athlete-specific guilt and shame has been under-researched. Reporting data from 174 junior elite cricketers, the present study utilized exploratory factor analysis in validating the Athletic Perceptions of Performance Scale, assessing three distinct and statistically reliable factors: athletic shame-proneness, guilt-proneness, and no-concern. Conditional process analysis indicated that APPS shame-proneness mediated the relationship between general (...) and athlete-specific distress. While APPS domains of guilt-proneness and no-concern were not significant mediators, they exhibited correlations in the expected direction with indices of psychological distress and well-being. The APPS may assist coaches and support staff identify players who may benefit from targeted interventions to reduce the likelihood of experiencing shame-prone states. (shrink)

A 57–year–old with an incurable cancer suffered an abdominal catastrophe, putting him in the ICU, comatose with no chance of survival. His attending oncologist had only met him once and had no knowledge of his goals of care. Lacking an advance directive the staff turned to his family, who said, “Do everything.” This loaded statement was thought to be a demand for futile care even though it ultimately proved a reflection of their emotional response to a terrible, unanticipated event, (...) not an irrational demand for useless care. A sympathetic exploration of the patient’s goals and expectations with his family using Buckman’s SPIKES format disclosed that their major concern was that he not die on his wife’s birthday. The family agreed to withdraw him from ventilator support the following day. Unraveling a medical conflict requires a sensitive process of shared decision–making based on a transparent process of clinical reasoning that synthesizes patient and family values with medical knowledge and ethical duties. Properly done, the outcome usually is a satisfactory experience for all concerned. (shrink)

Objective: To identify the frequency and nature of care conflict dilemmas that United States long-term care providers encounter, response strategies, and use of ethics resources to assist with dispute resolution. Design: An online cross-sectional survey was distributed to the Society for Post-Acute and Long-Term Care Medicine (AMDA). Results: Two-thirds of participants, primarily medical directors, have rejected surrogate instructions and 71% have managed family conflict. Conflict over treatment decisions and issues interpreting advance directives were frequently reported. Half of facilities lack a (...) formal dispute mediation policy. Only five respondents have called an ethics consult for assistance. Conclusion: Ethically tense care conflicts commonly arise in long-term and post-acute care facilities. Few facility procedures incorporate ethics resources into actual practice. Recommendations are made to create actionable policy, increase access to ethics services, and support staff skill development in order to improve the end-of-life care experiences for patients, families, and care facility staff. (shrink)

This paper will explore the power of history in affecting contemporary caring practice. Drawing on the author's personal experience as a social worker, researcher and parent of a daughter with learning disabilities, the article will consider the ways in which the experience of (and to an extent, nostalgia for) the ?heady days? of de-institutionalisation continues to influence staff perceptions about their work. In doing so, this article will critique normative notions of choice and control that are at the heart (...) of current moves towards self-directed support and personalised services. The author contends that staff who support people who have learning disabilities need something with which to compare and validate their practice. In the 1980s the hospitals were easily identifiable as something negative with which practice ?in the community? could be compared. In the twenty-first century the need for a comparator is still there, but the hospitals and many of their associated structures such as Adult Training Centres have gone. The paper argues that the family can be a contemporary structure against which current practice can be measured. (shrink)

_Covert treatment raises a number of ethical and practical issues in psychiatry. Viewpoints differ from the standpoint of psychiatrists, caregivers, ethicists, lawyers, neighbours, human rights activists and patients. There is little systematic research data on its use but it is quite certain that there is relatively widespread use. The veil of secrecy around the procedure is due to fear of professional censure. Whenever there is a veil of secrecy around anything, which is aided and abetted by vociferous opposition from some (...) sections of society, the result is one of two: 1) either the activity goes underground or 2) it is reluctantly discarded, although most of those who used it earlier knew it was needed. Covert treatment has the dubious distinction of suffering both such secrecy and disapproval. Covert treatment has a number of advantages and disadvantages in psychotic disorders. The advantages are that it helps solve practical clinical problems; prevents delays in starting treatment, which is associated with clinical risks and substantial costs; prevents risk of self-destructive behaviour and/or physical assault by patient; prevents relapse; and prevents demoralization of staff. The disadvantages are that it maybe used with malafide intent by caregivers with or without the complicity of psychiatrists; it may be used to force conformity in dissenters; and the clinician may land himself in legal tangles even with its legitimate use. In addition, it may prevent insight, encourage denial, promote unhealthy practices in the treating staff and prevent understanding of why noncompliance occurs in the first place. Some support its use in dementia and learning disorders but oppose it in schizophrenia. The main reason is that uncooperative patients of schizophrenia (and related psychoses) are considered to be those who refuse treatment but retain capacity; while in dementia and severe learning disorder, uncooperative patients are those who lack capacity. This paper disputes this contention by arguing that although uncooperative patients of schizophrenia (and related psychoses) apparently retain capacity, it is limited, in fact distorted, since they lack insight. It presents the concept of insight-unconsciousness in a patient of psychosis. Just as an unconscious patient has to be given covert medical/surgical treatment, similarly an insight-unconscious patient with one of the different psychoses (in the acute phase or otherwise) may also have to be given covert treatment till he regains at least partial insight. It helps control psychotic symptoms and assists the patient in regaining enough insight to realize he needs treatment. Another argument against covert treatment is that people with schizophrenia have the capacity to learn and therefore can learn that they are required to take medications, but if medications are given covertly it may well fuel their paranoia. However, it should be noted that the patient who has lack of insight cannot learn unless he regains that insight, and he may need covert treatment to facilitate this process. Covert treatment can fuel the paranoia, true, but it can also control the psychotic symptoms sufficiently so that regular treatment can be initiated. In a patient who refuses to accept that he is sick and when involuntary commitment is not an option to be considered, covert treatment is the only option, apart from physical restraint. Ultimately, a choice has to be made between a larger beneficence (control of symptoms and start of therapy) and a smaller malevolence (necessary therapy, but without the patient's knowledge and consent). A number of practical clinical scenarios are outlined wherein the psychiatrist should adopt covert treatment in the best interests of the patient. Ethical issues of autonomy, power, secrecy and malafide intent arise; each of these can be countered only by non-malfeasance (above all, do no harm) under the overarch of beneficence (even above that, dare to care). An advance directive with health care proxy that sanctions covert treatment is presented. Questions raised by the practical clinical scenarios are then answered. The conclusions are as follows: covert treatment, i.e, temporary treatment without knowledge and consent, is seldom needed or justified. But, where needed, it remains an essential weapon in the psychiatrist's armamentarium: to be used cautiously but without guilt or fear of censure. However, the psychiatrist must use it very judiciously, in the rarest of rare cases, provided: i) he is firmly convinced that it is needed for the welfare of the patient; ii) it is the only option available to tide over a crisis; iii) continuing efforts are made to try and get the patient into regular psychiatric care; iv) the psychiatrist makes it clear that its use is only as a stop-gap; v) he is always alert to the chances of malevolence inherent in such a process and keeps away from conniving or associating with anything even remotely suspicious; and vi) he takes due precautions to ensure that he does not land into legal tangles later. The need of the hour is to explore in greater detail the need and justification for covert treatment, to lay out clear and firm parameters for its legitimate use, follow it up with standard literature and, finally, to establish clinical practice guidelines by unconflicted authors. The term "covert treatment" is preferable to "surreptitious prescribing"; they should not be used synonymously, the latter term being reserved for those cases where there is malafide intent._. (shrink)

Next SectionObjective The purpose of this article is to investigate the need for ethics support in Dutch healthcare institutions in order to understand why ethics support is often not used in practice and which factors are relevant in this context. Methods This study had a mixed methods design integrating quantitative and qualitative research methods. Two survey questionnaires, two focus groups and 17 interviews were conducted among board members and ethics support staff in Dutch healthcare institutions. Findings (...) Most respondents see a need for ethics support. This need is related to the complexity of contemporary healthcare, the contribution of ethics support to the core business of the organisation and to the surplus value of paying structural attention to ethical issues. The need for ethics support is, however, not unconditional. Reasons for a lacking need include: aversion of innovations, negative associations with the notion of ethics support service, and organisational factors like resources and setting. Conclusion There is a conditioned need for ethics support in Dutch healthcare institutions. The promotion of ethics support in healthcare can be fostered by focusing on formats which fit the needs of (practitioners in) healthcare institutions. The emphasis should be on creating a (culture of) dialogue about the complex situations which emerge daily in contemporary healthcare practice. (shrink)

Volume 20, Issue 3, March 2020, Page 42-44.

AimHealthcare workers have directly provided care for COVID-19 patients, and have faced many additional sources leading to poor mental health. The study aimed to investigate the mental health problems and related factors among healthcare staff in Vietnam.MethodsA descriptive cross-sectional mixed methods study, combining quantitative and qualitative research methods, was performed among 400 healthcare workers working at the National Hospital for Tropical Diseases and Ninh Binh General Hospital from the first day of treatment for COVID-19 patients to May 01, 2020.ResultsThe (...) results showed that 8.0% of participants had stress, 17.5% of participants had anxiety, and 14.8% of participants had depression. Approximately 50% of participants reported that they had at least one of these symptoms. The findings illustrated that stress, anxiety, and depression were associated with the position in a hospital, health status during the COVID-19 pandemic, family members/relatives infected with COVID-19, physical and mental support from friends, family, and community, department, years of working, and the average work hours per day of healthcare workers exposed to COVID-19.ConclusionDuring the COVID-19 pandemic, healthcare workers who worked in the hospital providing treatment and care for COVID-19 patients dealt with mental health problems such as stress, anxiety, and depression. It is necessary to promote mental health among healthcare workers, to contribute to the fight against the COVID-19 outbreak in Vietnam. (shrink)

Obtaining prospective written consent from women to participate in trials when they are experiencing an obstetric emergency is challenging. Alternative consent pathways, such as gaining verbal consent at enrolment followed, later, by obtaining written consent, have been advocated by some clinicians and bioethicists but have received little empirical attention. We explored women’s and staff views about the consent procedures used during the internal pilot of a trial, where the protocol permitted staff to gain verbal consent at recruitment. Interviews (...) with staff and participating women. Data were analysed thematically and interviews were cross-compared to identify differences and similarities in participants’ views about the consent procedures used. Women and some staff highlighted benefits to obtaining verbal consent at trial enrolment, including expediting recruitment and reducing the burden on those left exhausted by their births. However, most staff with direct responsibility for taking consent expressed extreme reluctance to proceed with enrolment until they had obtained written consent, despite being comfortable using verbal procedures in their clinical practice. To account for this resistance, staff drew a strong distinction between research and clinical care and suggested that a higher level of consent was needed when recruiting into trials. In doing so, staff emphasised the need to engage women in reflexive decision-making and highlighted the role that completing the consent form could play in enabling and evidencing this process. While most staff cited their ethical responsibilities to women, they also voiced concerns that the absence of a signed consent form at recruitment could expose them to greater risk of litigation were an individual to experience a complication during the trial. Inexperience of recruiting into peripartum trials and limited availability of staff trained to take consent also reinforced preferences for obtaining written consent at recruitment. While alternative consent pathways have an important role to play in advancing emergency medicine research, and may be appreciated by potential recruits, they may give rise to unintended ethical and logistical challenges for staff. Staff would benefit from training and support to increase their confidence and willingness to recruit into trials using alternative consent pathways. This qualitative research was undertaken as part of the GOT-IT Trial. Date of registration 26/03/2014. (shrink)

This article aims to present the problem of the impact of artificial intelligence on respect for human dignity in the sphere of care for people who, for various reasons, are described as particularly vulnerable, especially seniors and people with various disabilities. In recent years, various initiatives and works have been undertaken on the European scene to define the directions in which the development and use of artificial intelligence should go. According to the human-centric approach, artificial intelligence should be developed, used (...) and monitored with people in mind, their needs and rights. It is artificial intelligence that should adapt to the rules set by people, not the other way around. The source of all human rights and freedoms is respect for human dignity. This is evidenced by numerous European, international, national regulations and documents. Respecting this value is also one of the works on the AI development. One of the areas of our life into which AI enters more and more boldly and which in the near future, due to demographic reasons and aging population, may be almost dominated by modern technologies, is the medical and care system. The usefulness of industrial co-robots made us think about the possibility of using similar devices in the non-industrial sphere, including in the sphere of care, nursing and therapy. Actually, despite the impressive development of technology and AI, intelligent robots/devices used for care, nursing or therapy (so-called care/nursing or therapy robots) perform rather simple activities. They provide information, navigate, bring something and give it (e.g. medicines, food), help to get up. They are an important support for medical staff in this respect. Performing tasks that are more complex in terms of technology and movement, such as feeding, washing, intimate hygiene, dressing or undressing, is still beyond the reach of the currently used robots. The question we must ask ourselves is whether, in the future, care robots will be able to perform such tasks, and should they do so? Will this lead to the replacement of human medical personnel in the performance of the above-mentioned activities with such robots. Would anyone want to be "looked after" by a soulless machine? Should potential wards/patients, in other words all of us in fact, have the right to object to being taken into the care of an intelligent robot? There is no doubt that intelligent robots have great potential, especially when it comes to ensuring or maintaining the independence or mobility of people with various health limitations. However, we must not forget about the risks and dangers they may generate. Even a simple robot generates serious legal and ethical problems. Who should be liable for damage caused in connection with improper care performed with the participation of a robot? Robots based on AI systems are able to collect a significant amount of sensitive data, for example through the face and speech recognition function. There is considerable scope for abuse in this area, not only in terms of personal data protection but also in terms of informational self-determination, privacy and dignity. Bearing in mind the above risks, the creation of a new right to object to being looked after by a robot should be considered. (shrink)

An Irish Government directive to close colleges amid the Covid-19 pandemic resulted in a switch to emergency remote teaching. Many lecturers unused to practicing online began teaching students who were unfamiliar with online learning. Completion of the semester does not necessarily indicate that it is practicable for a more extended period. This paper queries four aspects of the sustainability of emergency remote teaching: its acceptance by stakeholders; its impact upon student motivation and faculty workload; and its effect upon learning outputs. (...) Questionnaires administered to undergraduate design students and faculty captured their respective experiences of emergency remote teaching. Acceptance of an extended pivot to online learning is not guaranteed, but will surely form a central facet of academic continuity. Increased working hours associated with online teaching endangers the work-life balance of lecturers, yet the same staff must find ways to support student motivation. Faculty’s reduced expectations of student output places strain upon the sustainability of online education founded upon an unplanned pivot. The experience of emergency remote teaching has created an opportunity for all parties to leverage the affordances of online learning – the challenge will be to ensure that all aspects of any extended switch to online are sustainable. (shrink)

Background. In some organisations, traumatic events via direct or indirect exposure are routine experiences. A NICE review (2005; updated in December 2018) of Post-Traumatic Stress Disorder (PTSD) management in primary and secondary care did not address early interventions for trauma in emergency response organisations. Aims. This scoping review was designed to identify previous research which evaluated the use of early interventions following exposure to primary or secondary trauma, to report on the effectiveness of early interventions models. Method. A scoping (...) review was conducted to examine early interventions for trauma with staff in roles potentially exposed to trauma including: emergency response, military and humanitarian aid. Relevant data was extracted from included studies and outcomes were assessed using meta-ethnography. Results. Fifty studies of mixed quality met the inclusion criteria for this review. Synthesis of study outcomes found that early interventions help emergency responders to manage post-incident trauma when they: are delivered in a manner that respects distinct organisational culture; are supported by organisations and senior management, and; harness existing social cohesion and peer support systems within teams. Conclusions. This review demonstrates that early interventions support emergency responders following exposure to trauma when: tailored to the needs of the population, are supported by the host organisation, and harness existing social cohesion and peer support processes within a team or unit. We identify a number of recommendations for the delivery and evaluation of early interventions for psychological trauma in emergency response organisations. (shrink)

The relevance of the research In the face of increasing global competition, business was challenged to seek new methods for creating their competitive advantage and at the same time the decreasing budgets of higher education institutions were pressured to find new streams of financing. In both cases, collaboration is seen as an important method for achieving their objectives but universities of today have as well to find the appropriate balance between teaching, basic and applied research, and entrepreneurship. Ten types of (...) university-business collaboration are related quite directly to the missions of the university and the needs of business. Curriculum development and delivery is one of that ten, which aim is to develop human resources to modern society. A summary of benefits was identified in the academic literature as arising from UBC in relation to curriculum design and delivery for multiple stakeholders including academics, students, university administration, business and community. Overall, UBC may take various forms that are influenced by different factors but even if all stakeholders seeks the main purpose of this process they may get different benefits. The research aim was to identify the benefits of universities and business organizations in curriculum development. The objectives of the research: to determine the instruments and activities used for universities and business organizations collaboration, to identify universities and business organizations benefits from collaboration to the various stakeholder groups. Analysis of recent research and publications. UBC became the subject of education and management sciences. P. D'Este and M. Perkmann explored the factors of UBC, the types were identified by T. Davey, T. Baaken, V. Galan Muros, A. Meerman, T. Barnes, A. Gibbons and the levels of UBC were represented by B.N. Ponomariov, P.C. Boardman, T. Davey, R. Laužackas. The benefits of UBC to research quality have been studied by researchers T. Davey, M. Crespo, N. Carayol, H. Forsyth, R. Laxton, S. Lamichhane, T. Nath Sharma, P. Van der Sijde and H. Dridi, as a collaborative factor for learning improvement by researchers K. Ramakrishnan, N.M. Yasin, A. Draghici. An overview of the study of this object shows that it was mostly analysed in vocational training and in last ten years’ period the publications is growing in UBC. Research methodology. The paper seeks to represent the UBC benefits for different stakeholders and collaboration forms, which was used by university with the business organizations from leisure industry. Quantitative research was used to gain quantify opinions of benefits and instruments of UBC – and generalize results from a larger sample population. Methods applied for the research was scientific literature review, a questionnaire survey for business organization leaders and mathematical statistics. Conclusion. The benefits of the UVB were grouped according to the type of stakeholder's: society, university administration, academics, entrepreneurs, students. The benefits of business stakeholders include additional funding, access to education resources, lecturer and coordinator, support in evaluating the program and developing new study subjects. The highest rated benefit to others stakeholders from their view could be reducing academic staff training costs, as well as business information available to student projects, skills development and student employment opportunities and human resource development in the region. (shrink)

The Last Gift is an observational HIV cure-related research study conducted with people with HIV at the end of life (EOL) at the University of California San Diego. Participants agree to voluntarily donate blood and other biospecimens while living and their bodies for a rapid research autopsy postmortem to better understand HIV reservoir dynamics throughout the entire body. The Last Gift study was initiated in 2017. Since then, 30 volunteers were enrolled who are either (1) terminally ill with a concomitant (...) condition and have a prognosis of 6 months or less or (2) chronically ill with multiple comorbidities and nearing the EOL.Multiple ethical and logistical challenges have been revealed during this time; here, we share our lessons learnt and ethical analysis. Issues relevant to healthcare research include surrogate informed consent, personal and professional boundaries, challenges posed conducting research in a pandemic, and clinician burnout and emotional support. Issues more specific to EOL and postmortem research include dual roles of clinical care and research teams, communication between research personnel and clinical teams, legally required versus rapid research autopsy, identification of next of kin/loved ones and issues of inclusion. Issues specific to the Last Gift include logistics of body donation and rapid research autopsy, and disposition of the body as a study benefit.We recommend EOL research teams to have clear provisions around surrogate informed consent, rotate personnel to maintain boundaries, limit direct contact with staff associated with clinical care and have a clear plan for legally required versus research autopsies, among other recommendations. (shrink)

Philosophers have long recognized that the unique values of the individual physician effect medical-ethical decision-making. While not taking issue with this basic assumption, this article critically examines one discussion of how different philosophies (existential, utilitarian, and value realist) can influence a neurosurgeon's decision to operate upon a person having a malignant brain tumor. It also delineates and discusses a fund of ‘medical wisdom’ commonly available to any neurosurgeon and easily obtainable by both researcher and patient. The article suggests that those (...) in the humanities interested in studying the ethical decision-making process in a medical subspecialty become familiar with this fund of knowledge. It can provide a base for evaluating when and how individual medical decisions vary. In this specific instance, the medical knowledge base was used to direct attention to when and how ethical issues are identified and resolved within the staff clinical neurosurgical setting. An informal survey among resident and staff neurosurgeons supported the conclusion that philosophical analyses of medical-ethical decision-making are appreciated when case examples are carefully and accurately documented, when medical terminology is used correctly and when recognition of the practical limits placed on medical decision-making is given. CiteULike Connotea Del.icio.us What's this? (shrink)

This paper examines the difficulties of dealing with child labour in the supply chain. It begins by identifying a number of the factors which make global supply chains so difficult to manage. It goes on to outline a framework of different approaches that can be taken to managing the supply chain with relation to child labour, moving from national and international regulation, through to the role of NGOs and the companies themselves. Focusing on an ‘engagement’ strategy for dealing with child (...) labour, the paper traces a case study of Adidas‐Salomon and its attempts to implement their ‘standards of engagement’ in this area with relation to one of their supplier factories in Vietnam. The research draws on the direct involvement of one of the authors who visited the site and was able to interview staff and observe the operation in practice. Her findings are supported by wider work on the implementation of corporate approaches to human rights at a range of companies interviewed by another of the authors. The paper aims to highlight the issues needing to be addressed for companies considering the ‘involvement’ approach to child labour. It also aims to develop theory on our understanding of different approaches to corporate rights. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:An Exposition of The Divine Names, The Book of Blessed Dionysius by Thomas AquinasMichael J. Rubin, Elizabeth C. Shaw, and Staff*AQUINAS, Thomas. An Exposition of The Divine Names, The Book of Blessed Dionysius. Translated and edited with an introduction by Michael A. Augros. Merrimack, N.H.: Thomas More College Press, 2021. xxv + 549 pp. Cloth, $65.00The profound influence that Pseudo-Dionysius had on Aquinas’s thought, especially in his (...) metaphysics of participation and his apophatic theology, has been known for some time now, thanks to the excellent work of such scholars as Fran O’Rourke. One would therefore think that Aquinas’s Exposition of the Divine Names (his only commentary on the works of Pseudo-Dionysius) would have been translated a lot sooner. This delay is assuredly due not just to the difficulty of translating this work but also to a certain embarrassment felt by Thomists over Aquinas’s sincere belief that the “Dionysius” who wrote the Divine Names was the Areopagite whose conversion at the teaching of St. Paul is mentioned in the Acts of the Apostles. That the author calling himself “Dionysius” was in fact a theologian writing in the fifth or sixth centuries has been well established by modern scholarship. Hence, Thomists may have felt tempted to discount or at least pass over the influence of this author on Aquinas since it is discomfiting to think that the Church’s greatest theologian accorded such authority to an imposter.Michael Augros tackles these concerns head-on in the excellent introduction to his new translation of the Divine Names commentary. First, Augros points out that in past centuries a pseudonym was usually not an act of forgery but, rather, a way of concealing the author’s identity, which an early Christian theologian might well decide to do either out of humility or out of a desire “to avoid provoking certain prejudices” in those who disagreed with him in contemporary theological disputes. Moreover, it is likely that the work was never intended for the general public (who could easily mistake the pseudonym as genuine) but, rather, was written for those “already initiated in a particular Neoplatonic school of Christian theology,” who would recognize the author as being “one of their own” but without knowing his precise identity. Finally, in taking the particular name of “Dionysius,” the author of the Divine Names was indicating his intention for the work: Just as the biblical Dionysius was a Greek philosopher who converted to Christianity, so the works of Pseudo-Dionysius [End Page 345] are an attempt to reconcile Greek philosophy with the Christian faith.It therefore seems likely, as Augros observes, that Aquinas would still have accorded a great deal of respect to the Divine Names even if he had learned the truth of the author’s identity. The work would not have had the same deuterocanonical authority for him that comes with being written by a direct disciple of St. Paul himself, but “the inherent cogency, coherence, and beauty” of Pseudo-Dionysius’s theology would have been the same. Hence, Pseudo-Dionysius would surely have earned from Aquinas the “docile attitude” appropriate “for a philosopher and theologian of the first order, such as Boethius.”That Aquinas was right to see the author of the Divine Names as a master philosopher and theologian becomes evident when one dives into the text itself, in which Aquinas sees a truly dazzling order, both externally and internally. According to Aquinas, the Divine Names discusses those truths about God of which there are intelligible likenesses in creatures, such as goodness or wisdom, whereas the truths about God of which there are sensible likenesses (for example, “when God is called a lion, or a rock”) are treated by Pseudo-Dionysius in The Symbolic Theology; meanwhile, in the lost or fictional work The Divine Characteristics, Dionysius claims to have treated those truths about God (such as the Trinity) that cannot be known through any likenesses in creatures.Aquinas finds a still more intricate order within the Divine Names itself. Since this work is dedicated to “the divine names by which the processions of God to creatures are manifested,” the plan of the work... (shrink)

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

The establishment of research ethics committees (REC) in China’s higher education institutions (HEI) is lagging far behind western developed countries. This has at least partly directly led to anomie in scientific research ethics, as seen in the recent controversies involving a proposed human head transplant and gene-edited babies. At present, the problems for REC in China’s HEI include lack of regulation, informal ethics reviews, lack of supervision and insufficient ethics review capacity. To counteract these problems, suggested measures include mandatory formation (...) of formal ethics committee, administrative support from HEI, ethics approval letter prior to funding application, formulation of regulations and standard operating procedures, selecting and training for members and independent consultants, training for secretaries and staff, ethics training for investigators, and learning from the experience of HEI outside of China, such as the USA and Canada. The establishment of REC in China’s HEI will greatly enhance the overall quality of ethics reviews in China. In addition to better protecting the rights and welfare of human participants, it is also conducive to maintaining the reputation of China’s HEI. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.1 (2003) 99-102 [Access article in PDF] Living with Contested Knowledge and Partial Jennifer Clegg and Richard Lansdall-Welfare THESE CAREFUL AND CONSTRUCTIVE comments bring grist to our mill. Before responding to them, we observe first that they offer no substantive challenge to our thesis: ambiguities associated with meaning in the disabled life make it more likely that professional service providers will make dogmatic responses to (...) bereavement, and perhaps other essentially contested topics, responses that are defended by isolationism.Some welcome ideas came from left field to refresh our thinking, such as Colman's observations on the gendered nature of care. She reminded us that although the audit from which these cases came was established to investigate bereavement in general among adults with intellectual disability, its rough and ready sampling failed to ensure the expected range of bereavement types. Somehow the bereavements constructed as relevant for audit all transpired to concern the death of mothers. Moreover, of the six relatives who agreed to be interviewed concerning these bereavements, two were stepfathers and four were sisters. Colman underlines the invisibility of care work usually done by female family members: how wise or less wise decisions create the conditions for bereavement reactions, and how changes to care arrangements following bereavement fall most heavily on them. Traustadottir (2002) discussed the way new care initiatives often put pressure on female family members and staff to do more unpaid work. For example, Circles of Support encourages them to include people with intellectual disability in their personal social networks, without considering the personal costs. Such observations have yet to emerge from the umbrella of feminist research. Separatism has served feminism well, but issues of women and care do need to find their place in mainstream reviews.Another useful reminder from Colman is that the person with intellectual disability is not the only concern to families, although only a few adult services manage to hold wider systemic factors in mind (Clegg and Burnham 2000). If the person may make naïve comments at a funeral that would devastate family members whose needs take priority, the person will be excluded.The potency of bereavement was discussed twice. Casenave suggests that because "disability is a loss experience" bereavement resonates with it, casting some doubt onto the suggestion that our thesis generalizes to other contested topics. Reinders criticizes clinicians for being purblind to the tragic. The anonymous reviewer who questioned [End Page 99] the relevance of our discussion of the quality of "presence," a quality Reinders considers highly relevant, illustrates the point better than we can. Recognizing the way clinicians have little "patience with the notion of the tragic" encourages reflection on what other human experiences fail to capture our attention.Although these are all potentially valuable directions, we focus here on comments that may enhance our ability to work without dogma. Since at least the 1980s, clinicians in intellectual disability have criticized the discipline for using linear and univariate rather than complex and multivariate theories, and for a naïve search for magic answers (reviewed in Clegg 1993). It is our contention that little has changed, and that uncertain meaning and normalization combine to create ideal conditions for dogma. Reinders' exposition of the various uses of meaning in our article and in different linguistic and historical traditions develops a vital but neglected topic in intellectual disability, which we consider in some detail. We conclude by arguing that developments require us to distance ourselves from the universality and commonality inherent to normalization, and create new ways to appreciate particularity and diversity.The gist of Reinders' complex argument appears to be that the problems we identify in managing bereavement in intellectual disability stem from a modernist understanding of meaning that is erroneous. Implicitly, those who eschew its pursuit demonstrate the greater wisdom, because neither dialogue nor activities such as reflection can generate meaning that is unattainable. If we understand his position correctly, he contrasts two principal understandings of meaning: comprehension and apprehension.Comprehension is the illusory modernist idea that humans are agents who make sense of themselves... (shrink)

Background Standard interpretations of the ethical principle of respect for persons have not incorporated the views and values of patients, especially patients from groups underrepresented in research. This limits the ability of research ethics scholarship, guidance, and oversight to support inclusive, patient-centered research. This study aimed to identify the practical approaches that patients in community-based settings value most for conveying respect in genomics research. Methods We conducted a 3-round, web-based survey using the modified Delphi technique to identify areas of (...) agreement among English-speaking patients at primary care clinics in Washington State and Idaho who had a personal or family history of cancer. In Round 1, respondents rated the importance of 17 items, identified in prior qualitative work, for feeling respected. In Round 2, respondents re-rated each item after reviewing overall group ratings. In Round 3, respondents ranked a subset of the 8 most highly rated items. We calculated each item’s mean and median rankings in Round 3 to identify which approaches were most important for feeling respected in research. Results Forty-one patients consented to the survey, 21 (51%) completed Round 1, and 18 (86% of Round 1) completed each of Rounds 2 and 3. Two sets of rankings were excluded from analysis as speed of response suggested they had not completed the Round 3 ranking task. Respondents prioritized provision of study information to support decision-making (mean ranking 2.6 out of 8; median ranking 1.5) and interactions with research staff characterized by kindness, patience, and a lack of judgment (mean ranking 2.8; median ranking 2) as the most important approaches for conveying respect. Conclusions Informed consent and interpersonal interactions are key ways that research participants experience respect. These can be supported by other approaches to respecting participants, especially when consent and/or direct interactions are infeasible. Future work should continue to engage with patients in community-based settings to identify best practices for research without consent and examine unique perspectives across clinical and demographic groups in different types of research. (shrink)

Lesbian, gay, bisexual, trans and/or queer (LGBTQ) people experience profound health and social care inequalities. Research suggests that staff with negative attitudes towards LGBTQ people, are more likely to hold strong, traditional, religious beliefs. This article reports on a single case study with a newly qualified UK nurse who has since left the National Health Service. This is based on a single interview taken from a larger dataset derived from a funded scoping research study exploring religious freedoms, sexual orientation (...) and gender identity rights in older age care spaces. The interviewee described a toxic nursing culture on a hospital ward for older people. She recounted various incidents involving homophobic and transphobic practice and LGBTQ microaggressions which reportedly impacted the quality of nursing care. The findings are considered in relation to standards for anti-oppressive practice in nursing care, and how nursing students and staff can be supported in addressing practice relating to equality and diversity issues, specifically LGBTQ issues. They confirm the direct significance of addressing the needs and circumstances of LGBTQ people in nursing curricula and ongoing professional practice, and the need to further research, evaluate and progress translation of learning into improved quality care for diverse populations. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Healing Power of an Ethics ConsultLaura J. HoeksemaOur interdisciplinary team was inhaling and exhaling conflict, frustration, anger, confusion, guilt, and feelings of helplessness as we cared for a 21-year-old woman who was dying. We had regular disagreements about how our team should best care for her. She was receiving hospice care and had complex medical, psychosocial, physical, and emotional needs. She was frequently transitioning between hospice care at (...) home, living with different family members at different times, and hospice care in the hospital due to uncontrolled symptoms. This led to her having an inpatient hospice team made up of me—her physician—and a nurse, social worker, and chaplain and also an outpatient hospice team with a different physician, nurse, social worker, and chaplain. All of us cared for her regularly in our respective settings. Members of the two care teams advocated passionately for what they thought was best for her. At times, team members were advocating strongly for conflicting interventions. Every member of both teams experienced moral distress related to some aspect of her care.How could we move forward in a unified way to provide her with the best care possible when there was uncertainty and disagreement within the teams about whether we were providing her with ethically appropriate care?Several questions arose about her care:• What is our responsibility in protecting a vulnerable patient when there is concern she’s being taken advantage of by others?• How do we address concerns about possible opioid diversion? Was a dying patient not receiving the pain medication she needed because someone else was using it?• How do we address household members smoking in the presence of someone on oxygen?• Do we honor a dying patient’s wish to live in an environment that we’re concerned is unsafe for her and our staff?• When team members receive contradictory information from a patient, how do we develop a common understanding of the situation?• Was it appropriate for our team to spend hours and hours caring for her each day which prevented us from caring for other patients who also needed our support?• What is our responsibility in relation to supporting her family with their financial and legal concerns?We placed an ethics consult to help us think through the answers to these questions and address the intense moral distress of team members. After listening to us share our experiences, the ethicists acknowledged the complexities of caring for her and affirmed that we were doing a good job. This acknowledgment from someone not directly involved in caring for the patient was meaningful. Having colleagues, who weren’t impacted by the emotional intensity of caring for her, empathize with us helped us gain some perspective in the swirling tornado of our emotions.Moral distress was running rampant. Some team members were distressed that we were giving the patient too much autonomy to make decisions they felt put her at risk. Others felt we should restrict her autonomy significantly to protect her. Some were distressed by family members smoking near her when she was on oxygen. Others were distressed that the investment of time in caring for her was so great that we couldn’t care for other patients in ways they deserved. Team members were very passionate about their beliefs about what was right and wrong as we cared for her. [End Page 21]The ethics consultants addressed the conflicting ethical values and helped us feel more comfortable with the plan of care we developed together. We were asked thoughtful questions to help draw out sources of moral distress. We were given new ways of thinking about conflicting ethical values, which helped us understand the underlying reasons for the conflict our team was experiencing. Highlighting the ethical values that were in conflict and helping each of us understand that the specific aspects of her care that we found distressing were related to our personal values, helped decrease the intensity of disagreements and frustration. The ethicist’s ability to share this knowledge with our team was powerful. Our team realized that we weren’t frustrated or upset with each other. We came to understand that because of the... (shrink)

The study aimed to identify the knowledge management processes and their role in achieving competitive advantage at Al-Quds Open University. The study was based on the descriptive analytical method, and the study population consists of academic and administrative staff in each of the branches of Al-Quds Open University in (Tulkarm, Nablus and Jenin). The researchers selected a sample of the study population by the intentional non-probability method, the size of (70) employees. A questionnaire was prepared and supervised by a (...) number of specialists in order to obtain the results of the study. The study concluded that there is a positive direct relationship, that is, the higher the degree of application of knowledge management processes, the greater the degree of competitive advantage. Knowledge Technology came first with a score of 80.02% on all items. Competitive advantage came second with 81.74%. In the third place came "knowledge generation" where the total score on all paragraphs in this area (78.24%). In the fourth place, "knowledge transfer" (77.21%). "Developing and storing knowledge" came in fifth place (77.13%). "Acquisition of knowledge" came in sixth place (76.45%). Knowledge Organization ranked seventh (74.26%). The study recommended that the university should enable the employees to benefit from the experiences and expertise available to help generate knowledge. The University encourages the creation of knowledge through the system of incentives and open the way for creators to apply their creations and spread and invest in excellence and creativity. The university should design work performance levels based on the integration of knowledge and organize it according to policies that support freedom of research. The need for Palestinian universities to adopt a knowledge management approach. The need to adopt a system of incentives that rewards cognitive efforts, and give workers enough freedom to enable them to apply their knowledge. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:LettersMaxwell J. Mehlman, Susan R. Massey, Ronald M. Green, and Fred RosnerPhysicians and the Allocation of Scarce ResourcesMadam: We read with interest Dr. Pellegrino's commentary on our article in the December 1994 issue of the Kennedy Institute of Ethics Journal, and commend him for pointing out so well the different ways that law and ethics approach the issue of physician allocation of scarce resources.We wish to make one clarification. (...) Dr. Pellegrino states that we propose that fiduciary duties be abolished. Quite the contrary, our position is that fiduciary obligations are essential to the maintenance of trust—which we believe to be an efficient as well as an ethical element of the patient-provider relationship. If fiduciary duties are undercut, as we pointed out they are by the Oregon Medicaid legislation, then some other method of promoting trust must be established, and, as we point out in the article, it is difficult to identify what that method could be.Maxwell J. MehlmanandSusan R. MasseyThe Law Medicine CenterArter & HaddenCase Western Reserve UniversityCleveland, OHSchool of LawCleveland, OHReport of the Human Embryo Research PanelMadam: In the December 1994 issue of the Kennedy Institute of Ethics Journal, I reported on the controversy surrounding the work of the NIH Human Embryo Research Panel and the conclusions reached in its report, which was formally presented to NIH Director Harold Varmus on September 27, 1994. At that time, the report was to be reviewed by the Advisory Committee to the Director (ACD) until its next meeting in early December. I am writing to update your readers on the fate of the Panel's report.On the morning of December 2, 1994, following a previous afternoon of animated discussion, the ACD unanimously accepted the Report of the Human Embryo Research Panel. Panel members and members of the NIH staff who were present and had worked for nearly a year on the Report were gratified by this vote of confidence and by the strong support of NIH Director Harold Varmus.We had little time to enjoy this success. Within a matter of hours, the White House issued a press release in which President Clinton thanked the committee for its work and then, in a remark overruling one of the key recommendations in our report, stated: "I do not believe that federal funds should be used to support the creation of human embryos for research purposes, and I have directed that NIH not allocate any resources for such research." [End Page 83]As a Panel member and active participant in that day's events, my initial response was one of shock. I was particularly distressed that the President and his advisors chose a moment so late in the process to make their views known. Why had we worked for months, I asked, without a word of concern from the White House? Although Panel members were guided primarily by our perceptions of the ethical and scientific issues involved, some were close to the political realities of Washington and would have introduced these concerns into the Panel's deliberations.Within a matter of days, my own sense of outrage had diminished. First of all, it was clear that whatever the personal sources of the President's objections to the Panel's recommendations, this high level political intervention was inevitable. Less than a month before, on November 8, with the election of a majority House and Senate, the political environment for embryo research had changed dramatically. The previous June, 32 congressmen, most of them members of a minority Republican party, had signed a letter protesting the Panel's work. Now, one of the signers of that letter, Newt Gingrich, was destined to be Speaker of the House.Second, it became clear that the damage was not total. The President has forbidden NIH to support work involving the deliberate creation of embryos for research. Without exception, members of the Panel had come to the conclusion that some development of "research embryos" must be permitted to reduce the risks of new assisted reproductive technologies, to enhance scientific knowledge, and to develop new therapies for a range of serious diseases. All these... (shrink)

Undergraduate geoscience students are rarely exposed to history and philosophy of science. I will describe the experiences with a short course unfavourably placed in the first year of a bachelor of earth science. Arguments how HPS could enrich their education in many ways are sketched. One useful didactic approach is to develop a broader interest by connecting HPS themes to practical cases throughout the curriculum, and develop learning activities that allow students to reflect on their skills, methods and their field (...) in relation to other disciplines and interactions with society with abilities gained through exposure to HPS. Given support of the teaching staff, the tenets of philosophy of science in practice, of conceptual history of knowledge, and of ethics of science for society can fruitfully and directly be connected to the existing curriculum. This is ideally followed by a capstone HPS course late in the bachelor programme. (shrink)

This article examines how domestic violence impacts the lives and education of young children, children, and young people and how they can be supported within the education system. Schools are often the service in closest and longest contact with a child living with domestic violence; teachers can play a vital role in helping families access welfare services. In the wake of high profile cases of child abuse and neglect, concerns have been raised about the effectiveness of multi-agency responses to children (...) living with abuse. In the UK, the case of four-year-old Daniel Pelka who died in 2012 following abuse and starvation by his mother, who experienced domestic violence, and her partner, led to a serious case review. It found recording systems in Daniel’s school were not used consistently, and details held by different agencies were not collated to enable the formation of a coherent assessment. The lack of integrated working cited in the report echoes findings from previous serious case reviews. A strong correlation exists between domestic abuse and child abuse, with approximately half of all domestic violence situations involving direct child abuse. Children can also be affected indirectly by violence occurring in their home by seeing or hearing it taking place. This article examines the impact of domestic violence on the mental health of children, and the impact on their education. Violence in children’s lives often causes disruption to their schooling and harms the quality of their educational experiences and outcomes. The abuse children experience can result in emotional trauma, physical and psychological barriers to learning, and disruptive behavior in school, while the underlying causes of these problems remain hidden. Knowing when and how to seek advice from multi-agency professionals is an essential part of effective practice among school staff. Despite their vital role in identifying signs of abuse and signposting referral pathways, research indicates teachers often lack confidence and knowledge for such work. The article examines how the professional learning and professional confidence of teachers can be developed, and how recent policy and practice developments in the UK have the potential to influence work in this area. (shrink)

Background Moral distress is a major issue in intensive care units that requires immediate attention since it can cause nurses to burnout. Given the special conditions of patients in intensive care units and the importance of the mental health of nurses, the present study was designed to systematically review the factors affecting moral distress in nurses working in intensive care units. Methods PubMed, EMBASE, Web of Science, Scopus, and Science Direct were systematically searched for papers published between 2009 and (...) 2019. Original articles from quantitative and qualitative studies were reviewed. The CONSORT and STROBE checklists were used to assess the quality of the quantitative papers. The JBI checklist was applied for qualitative studies. Results Factors affecting moral distress in nurses include lack of nursing staff, nurses with inadequate experience, lack of support from organizations and colleagues, inadequate education and lack of knowledge of nurses, poor collaboration of physicians with nurses, ethical insensitivity and lack of teamwork, heavy workload, poor quality of care and moral violence and they are considered as risk factors for moral distress. Conclusion Many of the related causes are due to the nature of nurses’ work and it is necessary to manage the underlying conditions of this phenomenon so that it can be effectively prevented from spreading. Levels of moral distress require more attention of authorities in the use of prevention strategies and the reduction of effective factors in distress. (shrink)

We present results from a single case study based on semi-structured interviews with a student (a boy in school year 3) diagnosed with autism spectrum disorder and his school staff after participating in a short and small-scale intervention carried out in a socio-economically disadvantaged Swedish elementary school in 2019. The student participated in a seven week long intervention with a total of 12 philosophical dialogues (ranging from 45 to 60 minutes). Two facilitators, both with years of facilitation experience and (...) teacher degree and at least BA in philosophy, facilitated the majority of the dialogues and mainly followed a ”routine” procedure. The student was interviewed in direct connection to the end of the intervention about his experiences from the dialogues and his perceptions about whether and how the dialogues had influenced him. The student’s two teachers, who had participated in the dialogues as participants, were interviewed as a pair, also in direct connection to the end of the intervention, while the school principal was interviewed two years after the study. These staff interviews concerned the staff’s experiences of the influence of the dialogues on the students within the intervention as well as transfer effects to other contexts in school. The data from the study include detailed elaborations from a student perspective of different effects on the student’s communicative and cognitive development, which are in several respects supported also by staff reports. The results show that the student was able, interested, and willing to participate in philosophical dialogues, and our data point to several positive outcomes for the student in the communicative and cognitive domains. (shrink)

Artificial intelligence is increasingly inputting into various human resource management functions, such as sourcing job applicants and selecting staff, allocating work, and offering personalized career coaching. While the use of AI for such tasks can offer many benefits, evidence suggests that without careful and deliberate implementation its use also has the potential to generate significant harms. This raises several ethical concerns regarding the appropriateness of AI deployment to domains such as HRM, which directly deal with managing sometimes sensitive aspects (...) of individuals’ employment lifecycles. However, research at the intersection of HRM and technology continues to largely center on examining what AI can be used for, rather than focusing on the salient factors relevant to its ethical use and examining how to effectively engage human workers in its use. Conversely, the ethical AI literature offers excellent guiding principles for AI implementation broadly, but there remains much scope to explore how these principles can be enacted in specific contexts-of-use. By drawing on ethical AI and task-technology fit literature, this paper constructs a decision-making framework to support the ethical deployment of AI for HRM and guide determinations of the optimal mix of human and machine involvement for different HRM tasks. Doing so supports the deployment of AI for the betterment of work and workers and generates both scholarly and practical outcomes. (shrink)