Tertiary qualities have been studied primarily by Gestalt psychologists. My aim in this article is to revisit the theoretical assumptions regarding tertiary qualities. I start from the Galilean distinction of the qualities of experience, the Lockean subdivision of qualities, the subjectivist definition in aesthetics and the theoretical contribution of Gestalt theory, to show the theoretical value of ‘tertiary qualities’ in the current context of experimental psychological research. I conclude that tertiary (...) class='Hi'>qualities are a crucial keyword for an experimental psychology based on the primacy of perception. Such a perspective is in favour of a neo-Gestalt Experimental Phenomenology. (shrink)

Secondary and tertiary qualities are plausibly explained along dispositionalist lines. Concepts of such qualities are response-dependent, denoting properties that are partly mind/ brain -dependent. Unfortunately, dispositionalism is hard to square with extant versions of naturalistic theories of representation. In particular the standard naturalistic semantics of representational content cannot handle the question from either the subjectivist or the dispositional viewpoint. The paper proposes a remedy: the problem can be solved in a smooth and natural way, provided that we (...) revise and supplement the standard semantics in a rather obvious fashion, by allowing the mind/ brain -involving properties to figure within it. (shrink)

In the past years, many students had problems with their finances, especially their expenses for education. Many of the students are affected by the crisis financially, emotionally, and by their wellbeing. That is why the government provides programs that will help the students with their problems with school expenses, and that is through the Tertiary Education Subsidy (TES) of the Commission on Higher Education (CHED). Further, the primary goal of this study is to explore the TES Grantees' lived experiences, (...) challenges, and coping mechanisms. Furthermore, these are the study's findings: (1) The grantees find the TES very helpful regarding finances that will tackle their academic needs, such as tuition fees and school learning materials. (2) Many students value government assistance that motivates them to maintain their grades. (shrink)

Background: High ethical sensitivity positively affects the quality of nursing care; nevertheless, Chinese nurses’ ethical sensitivity and the factors influencing it have not been described. Research objectives: The purpose of this study was to describe ethical sensitivity and to explore factors influencing it among Chinese-registered nurses, to help nursing administrators improve nurses’ ethical sensitivity, build harmony between nurses and patients, and promote the patients’ health. Research design: This was a descriptive, cross-sectional study. Participants and research context: We recruited 500 nurses (...) from several departments in three tertiary hospitals. The Chinese Moral Sensitivity Questionnaire–Revised version and the Jefferson Scale of Empathy-Health Professionals were used to assess the nurses’ ethical sensitivity and empathy ability, respectively. Fifteen sociodemographic variables were included in the questionnaires. Ethical considerations: Informed consent was obtained from the participants regarding participation and data storage and handling. This program has been examined and supported by the research center of medical ethics and professional ethics of Guilin Medical University. The Approval No. was 2016RWYB04. The whole research process is conducted strictly according to ethical requirements. Results: The valid response rate was 84.40% ( n = 422). The total score of Chinese Moral Sensitivity Questionnaire–Revised was 35.82 ± 8.17. The subscale scores of moral responsibility and strength and sense of moral burden were 21.50 ± 4.91 and 14.33 ± 3.98, respectively. Significant differences were found among age groups, gender, years of working, category of profession, and quality of family communication regarding nurses’ ethical sensitivity ( p < 0.05). Regression analysis showed that the main factors influencing nurses’ ethical sensitivity were gender, years of working, quality of family communication, career satisfaction, and empathic ability. Discussion: Our findings suggest that Chinese nurses’ ethical sensitivity in tertiary hospitals in Guilin is at a medium level. Conclusion: The director of nursing schools and hospitals in China should pay attention to nurses’ ethical sensitivity and should intensify education and training to improve nurses’ ethical sensitivity. Further studies should focus on interventions aimed at improving Chinese nurses’ ethical sensitivity. (shrink)

BackgroundEthics consult services are well established, but often remain underutilized. Our aim was to identify the barriers and perceptions of the Ethics consult service for physicians, advance practice providers (APPs), and nurses at our urban academic medical center which might contribute to underutilization.MethodsThis was a cross-sectional single-health system, anonymous written online survey, which was developed by the UCSD Health Clinical Ethics Committee and distributed by Survey Monkey. We compare responses between physicians, APPs, and nurses using standard parametric and non-parametric statistical (...) methods. Satisfaction with ethics consult and likelihood of calling Ethics service again were assessed using a 0–100 scale using a 5-likert response structured (0 being “not helpful at all” to 100 being “extremely helpful”) and results presented using box plots and interquartile ranges (IQR).ResultsFrom January to July 2019, approximately 3800 surveys were sent to all physicians, APPs and nurses with a return rate of 5.5—10%. Although the majority of respondents had encountered an ethical dilemma (85–92.1%) only approximately half had ever requested an Ethics consult. The primary reason for physicians never having requested a consult was that they never felt the need for help (41%). For APPs the primary reasons were not knowing an Ethics consult service was available (33.3%) or not knowing how to contact Ethics (27.8%). For nurses, it was not knowing how to contact the Ethics consult service (30.8%) or not feeling the need for help (26.2%). The median satisfaction score (IQR) for Ethics consult services rated on a 0–100 scale, from physicians was 76 (29), for AAPs 89 (49), and nurses 70 (40) (p = 0.62). The median (IQR) of likelihood of consulting Ethics in the future also on a 0–100 scale was 71 (47) for physicians, 69 (45) for APPs, and 61 (45) for nurses (p = 0.79). APP’s and nurses were significantly more likely than physicians to believe that the team did not act on the Ethics consult’s recommendations.ConclusionsBased on the results presented, we were able to identify actionable steps to better engage healthcare providers—and in particular APPs and nurses—and scale up institutional educational efforts to increase awareness of the role of the Ethics consult service at our institution. Actionable steps included implementing a system of ongoing feedback that is critical for the sustainability of the Ethics service role. We hope this project can serve as a blueprint for other hospital-based Ethics consult services to improve the quality of their programs. (shrink)

Previous studies have offered a rationale for engaging students in small-group student talk for the planning of L2 individual writing. To further investigate whether such talk effectively promotes the quality of argument in the context of Chinese tertiary EFL learners’ argumentative writing and whether such effects could be retained, the current study adopted a quasi-experimental design with a pretest, a posttest, and a delayed posttest in two intact EFL classes. The performance of the intervention group and the comparison group (...) were scrutinized to examine the effects of the intervention. The analytic scores on six components of the writing task and the holistic writing scores cumulated of all these components were measured to see the immediate and sustained effects. Significant changes of the holistic scores in both the immediate posttest and the delayed posttest indicated that such small-group student talk enabled students in the treatment class to achieve better performance in the overall quality of argumentation compared with those in the comparison class. Statistical analyses revealed immediate and sustained effects of small-group student talk on the quality of counterargument claim, counterargument data, and rebuttal claim. Counterargument claim was the only element in which students in both classes made significant improvement, but the treatment class demonstrated a larger effect size. No discernible differences were found either between or within the treatment class and the comparison class with respect to the quality of claim, data, and rebuttal data across tests. Possible explanations concerning the findings and limitations of the study were discussed. (shrink)

The Emergency Department is a crucial medical treatment unit of hospital specializing in emergency medicine. EDs are responsible for providing immediate healthcare facilities to patients arriving without prior appointment. Thus, evaluating patient satisfaction is of immense importance for efficient service delivery. Very few studies are found in Pakistan, related to patients’ satisfaction and utilization of ED services both from demand and supply perspective of ED-Services Supply Chains. Data was collected to assess 200 patient’s satisfaction towards quality of healthcare services of (...) ED of Sindh Government Qatar Hospital, Orangi town-a tertiary care hospital in Karachi. Structured questionnaire was developed to interview patients and their attendants. Results of SPSS analysis revealed that 55% of patients were transferred to ED within 5 minutes, which shows efficient patient queues and flow management. 64.5% patient’s average LOS was between 40-60 minutes. 71% get the availability of basic facilities in ED. Majority of patients i.e. 96.5% and 90.5%, showed satisfaction with the time spent and treatment given by the doctor. Majority of the patients are satisfied with the services and performance of ED of a tertiary care hospital and 76% patients showed willingness to recommend ED of Government Qatar Hospital, Karachi to others. (shrink)

For all of the emphasis on quality improvement—as well as the acknowledged overlap between assessment of the quality of healthcare services and clinical ethics—the quality of clinical ethics consultation has received scant attention, especially in terms of empirical measurement. Recognizing this need, the second edition of Core Competencies for Health Care Ethics Consultation identified four domains of ethics quality: (1) ethicality, (2) stakeholders’ satisfaction, (3) resolution of the presenting conflict/dilemma, and (4) education that translates into knowledge. This study is the (...) first, to our knowledge, to directly measure all of these domains. Here we describe the quality improvement process undertaken at a tertiary care academic medical center, as well as the tools developed to measure the quality of ethics consultation, which include post-consultation satisfaction surveys and weekly case conferences. The information gained through these tools helps to improve not only the process of ethics consultation, but also the measurement and assurance of quality. (shrink)

Education is essential to life, and the epidemic affected everything. Parents want to get their kids the most important teaching. However, since COVID-19 has affected schools and other institutions, providing education has become the most significant issue. Online learning pedagogy uses technology to provide high-quality learning environments for student-centered learning. Further, this study explores the experiences and challenges faced by Filipino tertiary students regarding the lack of gadgets amidst online learning. Employing the Interpretative Phenomenological Analysis, the findings of this (...) study were: Some college students still have difficulty with online learning. Attending online classes is difficult, especially for students with limited resources. Smartphones, other gadgets, and internet connections play a significant role in online classrooms because they are the ones that students utilize while learning online, which is essential for successful participation in online higher education as well as for solving a variety of other difficulties in the new normal. Further, College students face similar health challenges. Having an online learning setup is not just about students' struggles with learning resources but also about their health issues. When our respondents used their smartphones for an extended period, they reported eye aches and blurred vision. They also said that some of their body parts, such as their legs and back, are aching, and feel pressured because they tend to overthink things in their surroundings, which causes them incredible difficulty in performing their best in attending online classes. Even though college students continue to suffer from a lack of learning resources during online sessions, they do their best to manage their needs and the scarcity of learning resources. Students have unique coping methods for dealing with difficulties in online classes. (shrink)

This study describes the results of a retrospective review of patients' charts who had an advanced directive (AD) and who were hospitalized in a tertiary, acute care teaching hospital. The purpose of the review was to understand from clinical, sociological, ethical and legal perspectives the nature and utility of ADs. Findings and implications of the review are discussed in terms of: patient demographics; diagnoses; quality of ADs; influence of ADs on clinical decisions; and legal aspects of ADs.

BackgroundThe quality of ethics consults is notoriously difficult to measure. Survey-based assessments cannot capture nuances of consultations. To address this gap, we conducted interviews with health professionals who requested ethics consults during the initial phase of the COVID-19 pandemic.MethodHealthcare professionals requesting ethics consultation between March 2020 and May 2020 at a tertiary academic medical centre were eligible to participate. We asked participants to comment on the consults they called and thematically analysed responses to identify features associated with optimal quality (...) consultations.ResultsOf 14 healthcare providers, 8 (57%) were women and professions were as follows: 11 (79%) medical doctors, 1 (7%) social worker, 1 (7%) physician assistant and 1 (7%) nurse practitioner. Two aspects of quality emerged: satisfaction and value. Themes within the domain of satisfaction included: responsiveness of the ethics consultant, willingness to consult, institutional role of the ethics service and identifying areas for improvement. When describing value, respondents spoke of the intrapersonal and interpersonal worth of consultation.ConclusionParticipants were generally satisfied with ethics consultation services, similar to opinions of those found in pre-COVID-19 survey studies. Our qualitative approach allowed for a richer exploration of the value of ethics consultation during the pandemic and has implications for ethics consultation services more broadly. Ethics consultation—emphasising both the process and outcome—created valuable moral spaces, promoting thoughtful and ethical responses to dilemmas in patient care. Future assessments should incorporate patient and family/surrogate perspectives and explore the domain of education as an additional quality measure. (shrink)

BackgroundThe issue of stigma is very important in the battle against HIV/aids in Africa since it may affect patient attendance at healthcare centres for obtaining antiretroviral medications and regular medical check-ups. Stigmatization creates an unnecessary culture of secrecy and silence based on ignorance and fear of victimization. This study was designed to determine if there is external stigmatization of people living with HIV and AIDS by health care workers at a tertiary hospital in KwaZulu-Natal province, South Africa. The study (...) investigated the impact of knowledge of HIV/aids by HCWs on treatment of patients, as well as the comfort level and attitude of HCWs when rendering care to PLWHA.MethodsA descriptive cross sectional study was designed to collect data using an anonymous self-administered structured questionnaire from 334 HCWs. The study was conducted in clinical departments of a large multidisciplinary 922-bed tertiary care teaching hospital in Durban, KZN.ResultsOverall HCWs had an above average knowledge about HIV/aids although some gaps in knowledge were identified. Tests of statistical significance showed that there was association between level of education and knowledge of HIV/aids ; occupation and knowledge of HIV/aids ; and gender and knowledge of HIV/aids. Test for comfort level was only significant for gender, with males showing more comfort and empathy when dealing with PLWHA. The study also revealed that patients were sometimes tested for HIV without informed consent before surgery, due to fear of being infected, and there was some gossiping about patients' HIV status by HCWs, thereby compromising patient confidentiality. The majority of HCWs showed a willingness to report incidents of stigmatization and discrimination to higher authorities, for better monitoring and control.ConclusionsAlthough knowledge, attitude and comfort level of HCWs taking care of PLWHA was above average, enforcement of existing antidiscrimination laws and continuing education in medical ethics and healthcare law, would greatly improve the performance of HCWs taking care of PLWHAs. More psychological support and counselling should be provided to HCWs, to further reduce the impact of stigmatization and discrimination against PLWHA. (shrink)

Background High levels of moral distress in nursing professionals, of which oncology nurses are particularly prone, can negatively impact patient care, job satisfaction, and retention. Aim “Positive Attitudes Striving to Rejuvenate You: PASTRY” was developed at a tertiary cancer center to reduce the burden of moral distress among oncology nurses. Research Design A Quality Improvement (QI) initiative was conducted using a pre- and post-intervention design, to launch PASTRY and measure its impact on moral distress of the nursing unit, using (...) Hamric’s Moral Distress Scale–Revised (MDS-R.) This program consisted of monthly 60-minute sessions allowing nurses to address morally distressing events and themes, such as clinicians giving “false hope” to patients or families. The PASTRY program sessions were led by certified clinicians utilizing strategies of discussion and mind-body practices. Participants Clinical nurses working on an adult leukemia/lymphoma unit. Ethical considerations This was a QI initiative, participation was voluntary, MDS-R responses were collected anonymously, and the institution’s Ethics Committee oversaw PASTRY’s implementation. Findings While improvement in moral distress findings were not statistically significant, the qualitative and quantitative findings demonstrated consistent themes. The PASTRY program received strong support from nurses and institutional leaders, lowered the nursing unit’s moral distress, led to enhanced camaraderie, and improved nurses’ coping skills. Discussion Measurement of moral distress is innately challenging due to its complexity. This study reinforces oncology nurses have measurable moral distress. Interventions should be implemented for a safe and healing environment to explore morally distressing clinical experiences. Poor communication among multidisciplinary team members is associated with moral distress among nurses. Programs like PASTRY may empower nurses to build support networks for change within themselves and institutions. Conclusion This QI initiative shows further research on moral distress reduction should be conducted to verify findings for statistical significance and so that institutional programs, like PASTRY, can be created. (shrink)

BackgroundSarcomas are a diverse group of neoplasms that vary greatly in clinical presentation and responsiveness to treatment. Given the differences in the sites of involvement, rarity, and treatment modality, a multidisciplinary approach is required. Previous literature suggests patients with sarcoma suffer from poorer quality of life especially physical and functional wellbeing. Adolescent and young adult patients are an underrepresented population in cancer research and have differing factors influencing QoL.MethodsRetrospective analysis of Young Adult patients enrolled in the Sarcoma Tissue Repository at (...) University of Iowa. QoL was assessed using the self-report FACT-G questionnaire at enrollment and 12 months post-diagnosis; overall scores and the 4 wellbeing subscales were calculated. Linear mixed effects models were used to measure the association between the rate of change in FACT-G subscale scores and baseline clinical, comorbidity, and treatment characteristics.Results49 patients were identified. 57.1% of patients had a malignancy involving an extremity. Mean FACT-G scores of overall wellbeing improved from baseline to 12 months. Social and emotional wellbeing did not differ significantly between baseline and 12 months. Physical wellbeing and functional wellbeing scores improved from baseline to 12 months. No difference was seen for FACT-G overall scores for age, sex, laterality, marital status, performance status, having children, clinical stage, limb surgery, chemotherapy, or tumor size. A difference was demonstrated in physical wellbeing scores for patients with baseline limitation compared to those with no baseline limitation. A difference was demonstrated in social wellbeing based on anatomical site.ConclusionYoung adults with sarcoma treated at a tertiary center had improvements in overall reported QoL at 12 months from diagnosis. Overall baseline QoL scores on FACT-G were lower than the general adult population for YA patients with sarcoma but at 12 months became in line with general population norms. The improvements seen merit further investigation to evaluate how these change over the continuum of care. Quality of life changes may be useful outcomes of interest in sarcoma trials. (shrink)

The distinction at the heart of Kant's philosophy is a metaphysical distinction: things in themselves are substances, bearers of intrinsic properties; phenomena are relational properties of substances. Kant says that things as we know them are composed "entirely of relations", by which he means forces. Kant's claim that we have no knowledge of things in themselves is not idealism, but humility: we have no knowledge of the intrinsic properties of substances. Kant has an empiricist starting-point. Human beings are receptive creatures. (...) We must be affected by the things of which we come to have knowledge. Kant believes that humility follows from this fact of receptivity. Humility does follow from receptivity, once a further premise is supplied. Kant believes that relational properties, causal powers in particular, are not reducible to intrinsic properties, and that intrinsic properties are therefore causally inert. Receptivity implies that we can have knowledge only of what can affect us. Irreducibility implies, in Kant's view, that intrinsic properties cannot affect us. Humility follows from these. This interpretation finds support in a range of critical and pre-critical writings, but there is a special focus on an early anti-Leibnizian argument for irreducibility that has considerable philosophical merit. One advantage of this interpretation is that the following famous contradiction is dissolved: things in themselves exist, and are the causes of phenomena, and we have no knowledge of them as they are in themselves. Moreover Kant's scientific realism, surprising on an idealist interpretation, makes sense. It does not conflict with Kant's claim that he makes all the qualities secondary--he means that he makes them powers, or in Locke's terms, tertiary qualities. Kant's "primary"/secondary quality distinction is superior to widely accepted alternatives, and his application of the irreducibility argument to the primary qualities challenges some current orthodoxies. Kant's commitment to the unobservables of science is permitted by his understanding of receptivity: we can have knowledge of anything that can affect us. Kant's scientific realism, and his humility, thus have a common source. (shrink)

XVI Psychologists have, however, shown that what we are primarily aware of is not a succession of sense-data but figures-ground phenomena: Wittgenstein's ambiguous duck-rabbit is merely one such example. They have also drawn our attention to the existence of tertiary qualities in perception, such as 'symmetry' and 'elegance' which are just as directly given as are the perceived colours red, green or yellow. It is interesting to note that Merleau-Ponty has made considerable use of Gestalt ideas in his (...) Phenomenology of Perception. One of the commonest reasons given by linguistic philosophers for not making direct use of the results of psychological research (although philosophers are usually willing to accept the first-hand results of physical science) is that philosophical accounts of perception and thinking are concerned with analysing the language in which these reports are made; that is to say, they are second-order enquiries. Often this approach is still more restricted and ordinary linguistic usage is taken as the yardstick against which questions relating to thought and perception are to be measured. The task of the philosopher is then con fined to the analysis of ordinary language. If he is more adventurous, as some writers on philosophical psychology are, he might go on to show how far the language used by psychological researchers falls short of the paradigms of common sense. (shrink)

Did God give things 'accidental powers not rooted in their natures', powers not rooted in intrinsic properties? For Leibniz, no. For Locke, the answer is disputed. On a voluntarist reading, yes, secondary and tertiary qualities are superadded (Margaret Wilson). On a mechanist reading, no, as for Leibniz (Michael Ayers). Since Locke viewed these qualities as relational, his view of relations ought to bear on the dispute. Locke said relation is 'not contained in the real existence of things'. (...) Bennett says Locke means relations are reducible (as Leibniz thought), which supports the mechanist reading. Bennett is mistaken: Locke means relations are irreducible, in harmony with his voluntarism. (shrink)

Many tertiary-level courses assess students’ participation in tutorial or online discussions. However, in educational and pedagogical research literature, criteria for assessing students’ skills in engaging with peers remain unclear. This article describes an online assignment with a set of participation criteria and a method for assessing the quality of students’ interactions with peers. The assignment focuses on students’ ability to utilise their critical thinking skills while engaging with peers on a particular topic. This includes abilities such as responding to (...) criticism, justifying one’s view and contributing to discussion. While the assignment is designed for a critical thinking course in a philosophy curriculum, the method and participation criteria may be adapted for assessment in other discipline areas. (shrink)

Teaching philosophy at pre-tertiary levels faces some fundamental challenges, including the misconception that philosophy is an abstract and esoteric field of study. This mind-set hinders teaching philosophy at all levels, particularly in the pre-tertiary stage. Nonetheless, philosophy holds significant cognitive values when taught to children. Therefore, it is crucial to find ways to simplify the process of learning philosophy, especially when children are in their formative years and have a greater capacity for learning. Children possess qualities necessary (...) for engaging with philosophy, such as curiosity. Leveraging these qualities makes it less daunting to introduce philosophy at pre-tertiary levels. Additionally, children have a visual and imaginative mind, enabling them to quickly grasp ideas and concepts through the use of modern technology. Integrating pictures, movies, and cartoons into philosophy education can enhance comprehension. For example, the movie “Divergent” contains philosophical themes that aid in understanding Plato’s concept of societal stratification. This article seeks to compare “Divergent” with Plato’s “The Republic” in terms of society’s hierarchical structure. Its objective is to demonstrate the value of movies and visual aids in teaching and learning philosophy, while also advocating for sensitivity to the underlying class dynamics in contemporary society. (shrink)

Contemporary reflection on the concept of value oscillates between positions that advocate absolutist realism and positions that propose total relativism. The present paper aims to distance itself from these two ways of reading the topic, rejecting any monolithic conception, and proposing a stratified theory of value. Beginning with an analysis of values that differentiates them from both “goods” and “valuations,” the author outlines an understanding of value that must be investigated in its multiple, interconnected layers. The stratification starts from the (...) role of the emotional sphere and comes down to a formal and absolute conception of the concept. The goal of the paper is to outline the different levels of validity of each proposed layer, which must be recognized and differentiated, with the aim of also capturing the difficulties and ambiguities that characterize the transition from one level to another. (shrink)

Background There is a high incidence of burns in China and the sequelae of post-burn scar growth, disfigurement, and other body image disorders can cause serious psychological distress to burns patients, and negatively affecting the patient’s dignity. However, there is limited knowledge relating to the dignity of burns patients. Aim To investigate the factors that affect dignity in burns patients. Design Cross-sectional study. Participants and research context We recruited 323 burn patients from the burn unit of a tertiary care (...) hospital. The Patient Dignity Scale, Burn Specific Health Scale-Brief, Hospital Anxiety and Depression Scale were used to assess burn patients’ dignity, quality of life, anxiety, and depression, respectively. 18 sociodemographic variables were included in the questionnaire. Ethical considerations Before the data were collected, the study protocol was reviewed and approved by the Ethics Committee of the Guangzhou Red Cross Hospital of Jinan University (Reference: 2022-149-02) and all patients provided and signed informed consent forms. Findings This study included 323 burns patients; of these, 26 (8%) had a mild loss of dignity, 94 (29.1%) had a moderate loss of dignity, 125 (38.7%) had a severe loss of dignity, and 78 (24.1%) had a very severe loss of dignity. The main factors that influence the loss of dignity in burns patients, including the department in which the patient was treated after their burns, gender, the clinical stage of the burn, quality-of-life, depression, resident medical insurance, the cause of the burn, and the burn site. Conclusions In most cases, the loss of dignity after burn injury is serious. Clinical health care professionals can provide personalized whole-life dignity care for patients by considering the factors that affect the dignity of burns patients, developing targeted dignity management programs, and implementing individualized interventions to maintain dignity, thus helping burns injury patients return to social life and work. (shrink)

We explored the care experiences and needs of the home caregivers of patients with amyotrophic lateral sclerosis (ALS) to improve their quality of life. We interviewed home caregivers in-depth and analyzed the data using Colaizzi's descriptive phenomenological method. We interviewed 11 home caregivers of patients with ALS with a disease duration between 1.5 and 4 years. Primary caregivers were predominantly female and were the patients' spouses. Daily caregiving time averaged 4–14 h for 0.5–3.5 years. Interview themes included helplessness and adaptation (...) to life changes, hopelessness, compassion for the patient’s prognosis, and expectation for diverse support. The study sample size was limited, as all participants were from a single tertiary hospital, and all patients had severe functional impairment. Caregivers of patients with ALS experience a considerable burden. Patients and their caregivers can benefit from diversified support channels, and assistive communication systems can be applied to home care. Future research will focus on in-home public long-term care services in China. (shrink)

Respecting patients’ rights is a fundamental aspect of providing quality healthcare. The present investigation attempts to explore the awareness among patients about their rights in a coastal township in India. A questionnaire-based cross-sectional study was carried out among 215 patients admitted to the wards of a tertiary care teaching hospital in Mangalore. Awareness among patients regarding their rights varied for various issues and ranged between 48.4 and 87.4 %. Awareness about patients’ rights was independent of gender, socio-economic and educational (...) status. Doctors were found to be the most common source of information for patient’s about their rights in the study. Doctors must conform to the relevant legislations and involve patients in all aspects of healthcare. There is a need to increase awareness among patients about their rights to ensure informed decisions and better health care services. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Veterans Affairs National Center for Clinical EthicsJames L. Bernat (bio)The veterans health administration is the largest health care system in the United States and, indeed, is larger that the health care system of many foreign countries. In February 1991 the Department of Veterans Affairs (V.A.) in Washington, D.C. awarded a contract to the clinical ethics group at the Veterans Affairs Medical Center in White River Junction, Vermont to (...) establish the V.A. National Center for Clinical Ethics. In this article I describe the organizational context, mission, operation, and future direction of the Center, which William A. Nelson, Ph.D., and I co-direct.The Veterans Health AdministrationThe Department of Veterans Affairs operates 171 hospitals providing services ranging from primary, secondary, and tertiary medical care to psychiatric hospitals, rehabilitation centers, and nursing homes. The V.A. also provides outpatient services at all hospitals and at dozens of free-standing outpatent clinics. V.A. medical centers employ over 14,000 physicians and serve approximately 4.5 million veteran patients (Hollingsworth and Bondy 1990; Mirvis 1990).The V.A. serves an important educational function, providing training sites for medical students, postgraduate physicians, and trainees in other health-related fields. Approximately 78 percent of V.A. medical centers are affiliated with medical schools. Over one-third of all American medical students and over 40 percent of interns and residents spend a portion of their training in V.A. medical centers. More than 100,000 students in all health-related fields train in V.A. facilities annually (Hollingsworth and Bondy 1990).Research is another mission of the V.A. Many academic physicians and scientists derive their research and salary funding from V.A contracts and awards. The V.A. Research Career Development Program provides the means for many medical school faculty members to achieve successful careers as scientists and clinical investigators. Although research accounts for only slightly more than 1 percent of the V.A. medical budget, two V.A. researchers have been awarded the Nobel Prize (Hollingsworth and Bondy 1990). [End Page 385]In comparison to other medical care settings, the average V.A. patient is likely to be older, poorer, male, less well-educated, more chronically ill, and more expensive to care for. Many patients first patronize the V.A. system after they have been bankrupted by the costs of a major illness. Unlike young, healthy patients ideally favored by health maintenance organizations, these patients immediately require large expenditures for hospitalizations, medications, and other treatments. Additional burdens have been placed on V.A. facilities by a record of chronic federal underfunding over the past decade, despite expanded patient censuses at every facility.Bioethical issues arise in V.A. facilities with great frequency for several reasons. Older and poorer patients are often sicker, have fewer home-support resources, and have completed fewer advance directives for health care. Chronic operational underfunding requires explicit health care rationing systemwide. Academic physicians within the V.A. system have multiple professional duties that have the potential for conflict. Although their primary duty is to their patients, they also must serve the federal government and their medical school academic supervisors. The practice of medical care rationing pits the physician's professional duty to his patient against his duty to the system (Mirvis 1990).The V.A. has responded to these bioethical demands with several initiatives. Hospital ethics advisory committees have been developed in nearly every V.A. medical center. The V.A. National Bioethics Committee has been empaneled to encourage uniform policies across the V.A. system concerning bioethical issues. Most recently, funds were provided for the V.A. National Center for Clinical Ethics.Functions of the National Center for Clinical Ethics (NCCE)The NCCE has a fourfold mission: 1) to enhance the quality of clinical ethics programs at all 171 V.A. medical centers nationwide; 2) to staff the V.A. National Bioethics Committee; 3) to assist administrators and planners in the V.A. Central Office on policy development concerning bioethical issues; and 4) to study, organize, and coordinate clinical, educational, and research bioethics programs throughout the system.Enhancing the quality of clinical ethics programs at V.A. medical centers is largely an... (shrink)

The objective of this article is to illustrate the issues and challenges which the higher education system in Bulgaria faces, with a particular accent on the phenomenon “education per kilogram”. The latter describes, in a popular language, the up-scaling of the university graduation, related to the mass proliferation of the higher education institutions, the facilitated access to enrolment through paid tuitions, etc. The big quantity of HEIs in the country is in a mismatch with the low percentage of GDP which (...) the government dedicates to education. The number of HEIs is also disproportionate against its population size - 54 HEIs in Bulgaria for population of 7.2 million. The research methodology includes a desktop study based on national statistical data and data from the governmentally-supported university rating system. An empirical survey, conducted among 250 tertiary education students enrolled in four Bulgarian universities, is a valuable contribution towards disclosing the pros and cons of the teaching practices in the tertiary education in the country. The first chapter describes at large the “education per kilogram” issue with regard to its possible origins, variations and consequences for the misbalance of labour market demand for certain qualifications and the universities supplies of qualified individuals. The second chapter reveals a comparative analysis by professional fields possible through the Ministry of Education and Science’s university rating system, i.e. students’ preferences for disciplines, universities and professions; the graduates’ professional fulfilment and how the income of the recent diploma-holders is a function of attending a particular HEI. The third chapter presents a sociological survey conducted among students in four Bulgarian universities which demonstrates learners’ attitudes towards various aspects of training, teaching methods and involvement in research assignments in the context of tertiary education. The main conclusion of the article is that the “universities per kilogram” trend brought about other corresponding characteristics, such as “students per kilogram”, “academic titles per kilogram”, etc. Hence, the large number of HEIs in Bulgaria has not led to improving the quality and efficiency of education, and yet does not respond adequately to the changing labour market demands for qualified professionals. (shrink)

The article discusses the strategies of translation of «machine texts» on the example of generative transformers (GPT). Currently, the study and development of machine text generation has become an important task for processing and analyzing texts in different languages. Modern technologies of artificial intelligence and neural networks allow us to create powerful tools for activities in this field, which are becoming more and more effective every year. Generative transformers are one of such tools. The study of generative transformers also allows (...) developers to create more accurate and efficient machine translation algorithms, which improves the quality of translations and improves the user experience. In this context, the features of machine texts created by generative transformers, their patterns, errors and imperfections, which require special translation strategies, deserve special interest. Today we can say that the generation of unique and relevant texts is a routine task that has been automated. Nevertheless, certain restrictions for the use of such texts still exist, in particular, their use requires the use of appropriate translation strategies. The paper proposes the author’s typology of translation strategies, where, taking into account the features of AST, it is proposed to add a substrategy of tertiary-moderation translation. (shrink)

Background The concept of career identity is integral to nursing practices and forms the basis of the nursing professions. Positive career identity is essential for providing high-quality care, optimizing patient outcomes, and enhancing the retention of health professionals. Therefore, there is a need to explore potential influencing variables, thereby developing effective interventions to improve career identity. Objectives To investigate the relationship between moral distress, moral courage, and career identity, and explore the mediating role of moral courage between moral distress and (...) career identity among nurses. Design A quantitative, cross-sectional study. Methods A convenient sample of 800 nurses was recruited from two tertiary care hospitals between February and March 2022. Participants were assessed using the Moral Distress Scale-revised, Nurses’ Moral Courage Scale, and Nursing Career Identity Scale. This study was described in accordance with the STROBE statement. Ethical consideration Research ethics approval was obtained from the researcher’s university and hospital where this study was conducted prior to data collection. Findings Moral distress is negatively associated while moral courage is positively associated with career identity among nurses. Moral courage partially mediates the relationship between moral distress and career identity ( β = −0.230 to −0.163, p < 0.01). Discussion The findings reveal a relationship between moral distress, moral courage, and career identity among nurses. Conclusion By paying attention to nurses’ moral distress and courage, healthcare providers can contribute to the development of effective interventions to improve career identity, and subsequently performance, among nurses. (shrink)

Objectives Medical futility at the end of life is a growing challenge to medicine. The goals of the authors were to elucidate how clinicians define futility, when they perceive life-sustaining treatment (LST) to be futile, how they communicate this situation and why LST is sometimes continued despite being recognised as futile. Methods The authors reviewed ethics case consultation protocols and conducted semi-structured interviews with 18 physicians and 11 nurses from adult intensive and palliative care units at a tertiary hospital (...) in Germany. The transcripts were subjected to qualitative content analysis. Results Futility was identified in the majority of case consultations. Interviewees associated futility with the failure to achieve goals of care that offer a benefit to the patient's quality of life and are proportionate to the risks, harms and costs. Prototypic examples mentioned are situations of irreversible dependence on LST, advanced metastatic malignancies and extensive brain injury. Participants agreed that futility should be assessed by physicians after consultation with the care team. Intensivists favoured an indirect and stepwise disclosure of the prognosis. Palliative care clinicians focused on a candid and empathetic information strategy. The reasons for continuing futile LST are primarily emotional, such as guilt, grief, fear of legal consequences and concerns about the family's reaction. Other obstacles are organisational routines, insufficient legal and palliative knowledge and treatment requests by patients or families. Conclusion Managing futility could be improved by communication training, knowledge transfer, organisational improvements and emotional and ethical support systems. The authors propose an algorithm for end-of-life decision making focusing on goals of treatment. (shrink)

Background Moral distress was first described by Jameton in 1984, and has been defined as distress experienced by an individual when they are unable to carry out what they believe to be the right course of action because of real or perceived constraints on that action. This complex phenomenon has been studied extensively among healthcare providers, and intensive care professionals in particular report high levels of moral distress. This distress has been associated with provider burnout and associated consequences such as (...) job attrition, with potential impacts on patient and family care. There is a paucity of literature exploring how middle and late career healthcare providers experience and cope with moral distress. Objectives We explore the experience of moral distress and the strategies and resources invoked to mitigate that distress in mid- and late-career healthcare providers practicing in paediatric intensive care, in order to identify ways in which the work environment can build a culture of moral resilience. Research design An exploratory, qualitative quality improvement project utilizing focus group and semi-structured interviews with pediatric intensive care front-line providers. Participants Mid-and-later career (10 + years in practice) pediatric intensive care front line providers in a tertiary pediatric hospital. Research context This work focuses on paediatric intensive care providers in a single critical care unit, in order to explore the site-specific perspectives of health care providers in that context with respect to moral distress coping strategies. Ethical considerations The study was approved by the Quality Management Office at the institution; consent was obtained from participants, and no identifying data was included in this project. Findings Participants endorsed perspective-building and described strategies for positive adaptation including; active, reflective and structured supports. Participants articulated interest in enhanced and accessible formal supports. Discussion Findings in this study resonate with the current literature in healthcare provider moral distress, and exposed ways in which the work environment could support a culture of moral resilience. Avenues are described for the management and mitigation of moral distress in this setting. Conclusion This exploratory work lays the groundwork for interventions that facilitate personal growth and meaning in the midst of moral crises in critical care practice. (shrink)

BackgroundMoral distress (MD) is an emotional and psychological response to morally challenging dilemmas. Moral distress is experienced frequently by nurses in the intensive care unit (ICU) and can result in emotional anguish, work dissatisfaction, poor patient outcomes, and high levels of nurse turnover. Opportunities to discuss ethically challenging situations may lessen MD and its associated sequela.ObjectiveThe purpose of this project was to develop, implement, and evaluate the impact of nursing ethics huddles on participants’ MD, clinical ethics knowledge, work satisfaction, and (...) patient care among ICU nurses.Sample and SettingThe sample, 32 nurses from three ICU settings in an 800-bed tertiary academic medical center, participated in six nursing ethics huddles over a two-month period.MethodsAlvita K. Nathaniel’s Theory of Moral Reckoning guided development of the nursing ethics huddle process.1 The Moral Distress Thermometer was administered at three data points: baseline level of MD, and pre- and post-huddle to determine changes in the subjects’ level of MD.2 Focused content analysis was used to analyze qualitative responses from questionnaires about the subjects’ perception of the effect of the huddles on work satisfaction and patient care. Knowledge attainment was evaluated via open-ended short-answer questions.ResultsOverall, use of nurse-ethicist-led nursing ethics huddles was associated with improved quality of work life, patient care, and clinical ethics knowledge. The change in pre- and post-nursing ethics huddles MD scores was statistically significant (p < 0.0001). (shrink)

Hidalgo1 argues that, contrary to widespread belief, active recruitment of health workers ‘generally refrains from enabling harm or facilitating wrongdoing’. In this commentary, I argue that the case is not yet convincing. There are a number of problems with the argument, only some of which I can sketch here. These include: Hidalgo gives an insufficient account of the relevant harms that are inflicted when healthcare workers emigrate. Relatedly, he does not take account of the underlying causes of migration and what (...) might assist in remedying the situation. He thus fails to catalogue a wide range of losses that are born when health workers emigrate from developing countries and fails to appreciate how his recommendations undermine some of the constructive initiatives that might assist poor, developing countries. Hidalgo misrepresents the situation in developing countries, incorrectly describing government funding of tertiary education as some kind of gift, rather than an investment in creating important human capital to provide for citizens’ needs, which can mean that fair returns on investment are quite justified. With the correct descriptions in place, the grounding for various duties to reciprocate is rendered secure. There are some important problems with the empirical studies cited such that they do not provide support for Hidalgo's argument.I begin with the case for . There are large disparities in life prospects between developing and developed countries. Indeed, this wide disparity is one of the main reasons healthcare workers want to leave in the first place. If that is the main reason healthcare workers seek to exit, it is not insignificant what would address the causal, underlying problems. How do we promote prosperity in developing countries? A lively debate on this topic flourishes. However, one factor that has widespread support from all sides of the debate is that the quality of …. (shrink)

Background: Ethical behaviour in nursing practice is integral to establishing a harmonious nurse-patient relationship and improving the quality of care. A multitude of factors shapes such behaviour. Therefore, it is crucial to understand the interplay between these factors. Research objectives: This study aimed to explore the mechanisms underlying the influence of moral sensitivity on nurses’ ethical behaviour and clarify the mediating role of moral courage. Research design: This cross-sectional quantitative study was conducted between July and August 2023. Participants and Research (...) Context: The sample comprised 465 clinical nurses from three tertiary hospitals in Zhengzhou City, Henan Province, China. Data were collected using the Chinese version of the Moral Sensitivity Questionnaire-Revised Version, Nurses’ Moral Courage Scale, and Ethical Behaviour Scale for Nurses. Data analysis was performed with SPSS 26.0 and AMOS 24.0, using descriptive statistics, Pearson correlation analysis, structural equation modelling, and bootstrapping methods. Ethical considerations: This study was approved by the Ethical Review Committee of Life Sciences of Zhengzhou University, China. Results: The participants were predominantly female (95.1%), with a mean age of 31.9 years. Moral courage and moral sensitivity were positively correlated with ethical behaviour. Moral sensitivity was positively associated with moral courage. Moral courage partially mediates the relationship between moral sensitivity and ethical behaviour. The indirect effect of nurses’ moral sensitivity on ethical behaviour was quantified through moral courage (indirect effect = 0.290). Conclusion: Moral courage intermediates nurses’ moral sensitivity and ethical behaviour. This conclusion provides nursing administrators with the insight that improving clinical nurses’ moral sensitivity and courage can contribute to ensuring appropriate ethical behaviour. (shrink)

Kleinschmidt's definition of the “Weltformenkreis” as the smallest systematical unit of affinity removes any danger of obliterating the type and at the same time opens a way for judging the superior taxonomic groups on principle differently from the subspecies of a “Formenkreis”.It is demonstrated that the characters of geographical subspecies are characters of apparent shaping, those of the species however are characters of construction and qualitative and autonomic ones. It is the type differentiating in quality that justifies the definition of (...) species. As the characters of type do not necessarily appear gradual and quantitative, but are qualitative, the types cannot be derived from one another, unless they are conceived by the common superordinate idea of the superior systematical category next in order.The distinct division of species is opposed to the hypothetical continuity of the pedigree, which cannot be explained by a consanguinity nor by an affinity based on reproduction. The pedigree, however, is an expression of the spiritual order of nature, in which the types appear as units hierarchically graduated and determined by entelechy, not by dead matter.Within the systematical units there is a creative evolution, steadily pursuing its aim and leading from the primitive stage to the differentiated one, beginning with a juvenile phase, which is followed by orthogenetic maturity and, finally, by the aged stage with its “detypification”. The adaptation to the environment may be also proved for the primitive forms and is an organic part of the whole design of the world for them as well as for the specialized and differentiated forms. — The formation of new types cannot be explained in a merely mechanical way; everywhere, even in the gens and genoms, we state ingenious modifications, which do not only bring about a reaction of a single modification to the whole, but operate from the whole. Since the origin of man, since the tertiary formation, the creation of species has completely ceased. There are only alterations of subspecific character.After a digressive treatise on the fundamental difference of man and animal in order to explain the type the superior systematical categories are characterized as spiritual realities. It is especially for the “genus” that a revision is necessary. The reality of the common origin of certain species within the genus is not based on reproduction , but on the superior totality comprising the species. Individuals can be conceived by the character of the species, species by the character of genus only. This is an evidence for the methodicalness of creative nature. It excludes any evolution of the genus “from bottom to top”, which is irregular, accidental or immediately formed by environment. From this we derive the comprehensive right of a natural system which now is more than mere classification.Kleinschmidt qui donne une définition du „Weltformenkreis” comme la plus petite unité d'affinité systématique, déjoue le danger d'oblitérer le type et offre, en même temps, la possibilité de juger les groupes taxonomiques supérieurs par principe différemment de la souspèce d'un „Formenkreis”.Nous démontrons que les caractères des souspèces géographiques sont des caractères du façonnement extérieur, tandis que ceux de l'espèce sont des caractères de la construction d'une manière qualitative et autonome. Le type différent en qualité justifie seulement la définition de l'espèce. Comme les caractères du type n'apparaissent pas nécessairement graduels et quantitatifs, mais sont au contraire, qualitatifs, les types ne se dérivent pas l'un de l'autre, à moins qu'ils ne soient compris par la commune idée supérieure du plus sublime groupe systématique.La division distincte des espèces s'oppose à la continuité hypothétique de la généalogie, qui ne s'explique pas par une consanguinité ni par une affinité se fondant sur la reproduction, mais qui est plutôt une expression du régime spirituel de la nature, dans lequel les types se présentent comme des unités rangées hiérarchiquement et réglées par l'entéléchie et non par la matière.Dans les unités systématiques il y a une évolution créatrice qui tend continuellement à son but et mène de la phase primitive à la phase différentiée commençant par un état juvénile, qui est succédé par la maturité orthogénétique et enfin par l'âge avec sa „détypification”. L'adaptation au milieu est démontrée pour les formes primitives et représente un élément organique du grand projet mondial pour elles aussi bien que pour les formes spécialisées et différentiées. — La formation de types nouveaux ne s'explique pas seulement d'une manière mécanique; partout, même dans les „genes” et les „genomes”, nous observons des transformations ingénieuses, qui ne sont pas seulement une réaction d'une modification particulière à l'ensemble, mais un effet de l'ensemble. Depuis l'origine de l'homme, depuis la période tertiaire la formation d'espèces est complètement finie. À présent il n'y a plus que des variations d'un caractère souspécifique. Après un traité digressif sur la différence essentielle de l'homme et de l'animal pour expliquer le type les groupes systématiques supérieurs sont caractérisés comme des réalités spirituelles. C'est surtout pour le genre qu'une révision est nécessaire. La réalité de la racine commune de certaines espèces dans le genre ne se fonde pas sur la reproduction , mais sur la totalité supérieure qui implique toutes les espèces. Des individus sont compris par le caractère d'espèce, des espèces seulement par le caractère de genre. C'est une preuve de la méthode de la nature créatrice. Elle exclut une évolution de genre „du bas en haut”, qui est irrégulière, faite par hasard ou formée directement par le milieu. De là nous dérivons le droit compréhensible d'un système naturel, qui est désormais plus qu'une simple classification. (shrink)

Birth asphyxia is the most common single cause of death in term newborn infants. The majority of deaths in developed countries follow decisions to withdraw intensive care. Recent technological advances, particularly the use of magnetic resonance imaging (MRI) of the brain, may affect the process of prognostication and decision-making. There is little existing evidence about how prognosis is determined in newborn infants and how this relates to treatment withdrawal decisions.An exploratory qualitative study was performed using in-depth semi-structured interviews with a (...) sample of ten neonatologists from tertiary intensive care units in the UK. Participants were purposively selected to ensure a range of experience and type of unit. They were asked about the process of prognostication for infants with birth asphyxia and decisions about treatment withdrawal. Interviews were transcribed and thematically analysed.MRI played a significant role in decision-making about life-sustaining treatment for a number of clinicians. Clinicians did not identify particular ethical concerns related to MRI, though wider discussion revealed issues relating to uncertainty around predictions, the timing of prognostication and decision-making, and difficulty in predicting quality of life. (shrink)

This paper focuses on the _ethics of how_ to approach the introduction of MAiD as an organizational ethics challenge, a focus that diverges from the traditional focus in healthcare ethics on the _ethics of why_ MAiD is right or wrong. It describes a method co-designed and implemented by ethics and medical leadership at a tertiary hospital to develop a values-based, grassroots response to the decriminalization of assisted dying in Canada. This organizational ethics engagement method embodied core tenants that drew (...) inspiration from a variety of sources, including poetic ones. These tenants are: make the problem bigger; focus on values; cultivate open moral spaces; and trust emergence. The paper describes how these tenants were put into practice in order to create a rigorous and sustainable MAiD program that delivers high-quality care to patients and families while honoring the moral diversity of the hospital workforce. One of the goals in sharing this method is to provide a roadmap for healthcare organizations in Canada and other jurisdictions around the world that are facing the challenge of responding to patient requests for MAiD following the decriminalization of this care option. (shrink)

Over the past few years we have seen an increasing number of legal proceedings related to inappropriately implemented technology. At the same time career paths have diverged from the foundation of statistics out to Data Scientist, Machine Learning and AI. All of these new branches being fundamentally branches of statistics and mathematics. This has meant that formal training has struggled to keep up with what is required in the plethora of new roles. Mathematics as a taught subject is still based (...) in decades old teaching specifications and has not been updated centrally as a curriculum to include new technologies, coding or ethics. This subject area is firmly split between ICT and Mathematics in secondary school, continuing on to be split between Computer Science and Mathematics at University. As we move forwards with technology we see these once seperate fields becoming increasingly intertwined. We propose that existing provision for concepts such as ethics and societal responsibility in analysis currently exist but have not been incorporated into the mainstream curriculum of School or University. This is partially due to the split between fields in an educational setting but also the speed with which education is able to keep up with Industry and its requirements. Principles and frameworks of socially responsible modelling beginning at school level means that ethics and real-life modelling are introduced much earlier than normal. Integrating these concepts with philosophical principles of society and politics ensures a suitable background for future modellers and users of technology to draw on. Modelling is currently undertaken in technical sciences at University but the Subject Benchmark Statements are not current (Subject Benchmark Statements describe the nature of study and the academic standards expected of graduates in specific subject areas. They show what graduates might reasonably be expected to know, do and understand at the end of their studies). Even in 2019 the UK did not yet have Benchmark Statements that discuss the learning to be done in Higher Education around AI and advanced Machine Learning. Where there is provision for AI and Data Science within degree courses ethics is not generally highlighted as a key concept. As such there can be a lack of focus on the teaching of modelling or ethics as specific skills. The skills required to use a basic statistical model, for example would not be sufficient to start from scratch and build an ethical model reflecting real-world scenarios with which to inform policy or organisational decision making. This is a skill in itself and includes such aspects as awareness of data quality, ethics, user implementation problems, context and an understanding of the environment that the model is being created in. As the field of analytics has progressed so quickly in the last decade modules such as those covering AI have simply been bolted on to Maths or Computing degrees rather than being fully detailed as key areas of study or driving new, more integrated courses of study. This paper posits that gaps at primary, secondary and tertiary educational levels need to be addressed. Implementing and integrating key concepts from school level is essential so that areas such as assumptions, caveats, quality assurance and answering the right questions with constructive challenge become a cultural fixture. This not only helps developers of technology but users of rapidly developing technology also. In addition, leadership and soft skills as part of this education will ensure that a cultural shift can take place and promote continuous improvement in analysis within organisations. The addition of key concepts throughout the educational system and the updating of potentially outdated curriculums is key to ensuring a functional society. A society where every citizen is a user of tech and those that develop it can be ethical and socially responsible in its development. (shrink)

This study assessed the attitudes and needs of physicians and health professional staff at a tertiary care hospital in Canada regarding the introduction of physician assisted dying (PAD) during 2015–16. This research aimed to develop an understanding of the wishes, concerns and hopes of stakeholders related to handling requests for PAD; to determine what supports/structures/resources health care professionals (HCP) require in order to ensure high quality and compassionate care for patients requesting PAD, and a supportive environment for all healthcare (...) providers across the moral spectrum. This study constituted a mixed methods design with a qualitative descriptive approach for the study’s qualitative component. A total of 303 HCPs working in a tertiary care hospital completed an online survey and 64 HCPs working in hospital units with high mortality rates participated in 8 focus group discussions. Both focus group and survey data coalesced around several themes to support the implementation of PAD following the decriminalization of this practice: the importance of high quality care; honoring moral diversity; supporting values (such as autonomy, privacy, beneficence); and developing resources, including collaboration with palliative care, education, policies and a specialized team. This study provided the foundational evidence to support the development of the PAD program described in other papers in this collection, and can be a model for gathering evidence from stakeholders to inform the implementation of PAD in any healthcare organization. (shrink)

Acceptance of elderly or marginal health individuals as kidney donors is debated, with practices varying between centres. Transplant recipients, live kidney donors and health-care professionals caring for patients with renal failure were surveyed regarding their views on live donor kidney transplantation (LDKT) of marginal health (diabetes, hypertension, atherosclerosis, obesity, etc.) and elderly donors. Participants were recruited within a tertiary renal and transplant centre and invited to participate in focus groups and structured interviews. They also completed an anonymous questionnaire. Of (...) 464 participants who completed the questionnaire (36% health-care professionals and 64% patients), 49% and 64%, respectively, stated that marginal and elderly donors should be accepted for LDKT. In the structured interviews, emphasis was given to presenting to donor, recipient and their respective families a calculated risk regarding the effect that either a nephrectomy or transplant has on long-term quality of life. Participants stated that an independent third party in addition to the transplant team should discuss involved risks. Issues of ‘how desperate’ the recipient's situation is should also be considered. Health-care professionals stated that regardless of the strength of will of an individual to donate a kidney (despite age, health problems or personal risk), they should always have the right to say ‘no’ if performing a specific LDKT was against their professional and ethical values. About half of those surveyed considered that marginal health and elderly donors were acceptable for LDKT. Emphasis was given to the explanation to donors and recipients of the risks involved in such transplantation. (shrink)

The endoplasmic reticulum (ER) uses various mechanisms to ensure that only properly folded proteins enter the secretory pathway. For proteins that oligomerize in the ER, the proper tertiary and quaternary structures must be achieved before their release. Although some proteins fold before oligomerization, others initiate oligomerization cotranslationally. Here, we discuss these different strategies and some of the unique problems they present for the ER quality control system. One mechanism used by the ER is thiol retention. Thiol retention operates by (...) monitoring the redox state of specific cysteine residue(s) and was discovered in studies on the assembly of IgM, a complex oligomeric glycoprotein. This system is also involved in retaining other unassembled proteins in the ER. Mutations that result in uneven numbers of cysteine residues can subject yet other proteins to thiol retention, altering their oligomerization status and function. The implications of these results on the effects of thiol retention on protein function and cell fate are discussed. BioEssays 20:546–554, 1998. © 1998 John Wiley & Sons Inc. (shrink)

Background: The intensive and critical care units are high-dependency areas, with patients requiring complex care. The intubated status of the intensive and critical care patients makes them dependent on healthcare providers not only for acute care, but also for intimate care, imposing a threat to their dignity. Nurses, being the central care providers, become the stakeholders for dignity promotion. The incorporation of dignity in patient care improves the quality of care, and promotes the health and well-being of intubated patients. Objective: (...) The purpose of the study was to explore nurses’ perceptions about the dignity of intubated patients in the intensive and critical care units. Research design: A qualitative descriptive exploratory study design was used to explore the nurses’ perceptions about the dignity of intubated patients. Participants and research context: The intensive and critical care nurses of a tertiary care hospital were recruited using the purposive sampling technique. The data were collected through in-depth individual interviews, using a semi-structured interview guide. The findings were manually analyzed into themes and categories through content analysis. Ethical consideration: The study was conducted after the approval from the Ethical Review Committee of the Aga Khan University. Findings: Four major themes emerged from the data analysis: (1) two sides of the contemporary nursing practice; (2) benefits of dignified nursing care; (3) challenges to the dignity of intubated patients; and (4) strategies for promoting the dignity of intubated patients. Discussion: Dignity incorporates both the science and the art of nursing. The provision of dignified care is the core component of the quality nursing care and patient well-being in the high-dependency units. Conclusion: This is the first exploratory and descriptive study conducted in Pakistan that explored the nurses’ perceptions about the dignity of intubated patients, and also generated contextual understanding about the phenomenon. (shrink)

This article gives a survey of the position of migrant workers in the Belgian labor market and social security system. Total employment of migrants has increased from 114,000 in 1954 to 224,900 in 1970.In contrast to overall employment in the Belgian economy, it went on climbing till 1978, up to a 245,900 level. Beyond this year, forecasts point at a slight decrease. Since WWII, the gravity point of the sectoral division of migrant workers has shifted from minig and industry, to (...) industry and tertiary activities. The share of industry in the employment of migrants bas remained relatively stable, in contrast to the tertiary sector, that witnessed a considerable expansion. However, the latter has not contributed substantially to the quality level of the average guest worker's job.On the whole, there is a strong correspondence between the unstable position of migrants in the labor market and their demographic characteristics on one side, their participation in the social security system on the other side. Their young family structure is reflected in a high share in family allowances and a limited appeal to pension funds. Statistical analysis at the aggregate level does not point at discriminatory practices vis-à-vis migrants and their families in social security ; but at thedisaggregate level and through the inspection of laws, regulations and international conventions, it appears that non-EEC nationals, with an unstable professional career, do not have the same rights as Belgians or EEC-citizens having a confortable position in the labor market and the social security system. In order to guarantee the rights of the farmer, the author suggests to establish a citizenship entitling to full social security rights after five years of regular residence in Belgium. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Otto Rudolph Ortmann, Music Philosophy, and Music EducationDavid J. GonzolWhat is music? What should we teach when we teach music? How should we? In the early twentieth century, these most foundational questions relating to music education were addressed by the highly regarded, though less well known, educator and researcher, Otto Rudolph Ortmann. In 1922, he published an article in which he outlined a theory of musical experience, developing aspects (...) of the physics of sound, qualitative theory, and Gestalt psychology, prefiguring important ideas in music philosophy. Ortmann highly valued his theory, utilized it in other research throughout his career, and influenced others such as Carl Seashore. Few, however, seem to be aware of his work or its implications for music education.1The seminal 1922 article, "The Sensorial Basis of Music Appreciation," was written while Ortmann was teaching at the Peabody Conservatory of Music and Johns Hopkins University in Baltimore, Maryland.2 While this article has received little attention, much of his other research has been widely and well received.3 "Papa Ortmann," well beloved of family and students, had a career Gerig characterized as "a wedding between Materia Medica and Frau Musica."4 A prolific [End Page 160] researcher, superb musician, and excellent teacher, he published articles on music theory (one of which was reprinted and extended in 1983), musicology, music reading, ear training, synesthesia, and jazz.5 His research on piano performance, particularly his two books,6 is regarded as definitive; it has been discussed in a thesis and four dissertations; some of it has been replicated. In Famous Pianists and Their Technique, Gerig devoted a chapter to Ortmann.7 Ortmann's theory of listening types, in effect a theory of music cognition,8 was accepted by Robert Neidlinger, Doreen Rao, and Bennett Reimer.9 In the 1992 Handbook of Research on Music Teaching and Learning, F. R. Wilson and F. L. Roehmann praised the significance of Ortmann's body of research as undiminished in importance in music education.10It may be that Ortmann's "Sensorial Basis"theory received little attention at the time because too few were interested in such theories or in the synthesizing of science and psychology or the touching on philosophy that he employed. Although he influenced Seashore, the philosophical issues he began to explore would be developed more strongly only decades later, by philosophers such as Monroe Beardsley, Peter Kivy, and Jerrold Levinson. It seems that Ortmann's theory not only prefigures some ideas in recent music philosophy, but supports them as well. If it does, then our increased understanding of music can provide a firmer basis for developing better music education-one of Ortmann's aims. In this article I will describe his theory, sketch how it aligns with subsequent research, and consider its value today. Ortmann attempted a comprehensive explanation of music's nature; as far as his explanation is accurate, that far it can help us understand music and in turn music education.Three "Attributes"At the turn of the 1900s, it was popular to refer to "attributes" of sound. Ortmann posited that all sensation, including sound, has three types of attributes. The primary attribute he termed extensity, by which he meant the breadth of the sensation that is perceived. Extensity has three forms, transtensity (frequency), intensity (strength), and protensity (duration). These can be perceived individually but also as sound's secondary attributes, chief of which is quality. Tertiary attributes of sound are made through association, either by (a) contiguity, linking a sound's quality with things experienced near in time to the sound, or by (b) similarity, associating the quality with sensations of like extensity (for example, the expressive brightness of a sound and a light). Ortmann believed that tertiary attributes form "the threshold of musical imagination, and imagination in turn, of musical enjoyment."11 Accordingly, he concluded that music could express many things, and that this is dependent on listeners, their individual histories, and their entire field of sensations. [End Page 161]The Primary Attribute of ExtensityIn the Renaissance, Benedetti and Galileo found that pitch was related to frequency, and in 1702, Sauveur was the first to state that overtones affect timbre. In 1863, Helmholtz... (shrink)

Background While the number of emergency patients worldwide continues to increase, emergency doctors often face moral distress. It hampers the overall efficiency of the emergency department, even leading to a reduction in human resources. Aim This study explored the experience of moral distress among emergency department doctors and analyzed the causes of its occurrence and the strategies for addressing it. Method Purposive and snowball sampling strategies were used in this study. Data were collected through in-depth, semi-structured interviews with 10 doctors (...) working in the emergency department of a tertiary general hospital in southwest China. The interview data underwent processing using the Nvivo 14 software. The data analysis was guided by Colaizzi’s phenomenological analysis method. Study findings This study yielded five themes: (1) imbalance between Limited Medical Resources and High-Quality Treatment Needs; (2) Ineffective Communication with Patients; (3) Rescuing Patients With no prospect of treatment; (4) Challenges in Sustaining Optimal Treatment Measures; and (5) Strategies for Addressing Moral Distress. Conclusion The moral distress faced by emergency doctors stems from various aspects. Clinical management and policymakers can alleviate this distress by enhancing the dissemination of emergency medical knowledge to the general public, improving the social and economic support systems, and strengthening multidisciplinary collaboration and doctors’ communication skills. (shrink)

Introduction Nurses’ moral courage (NMC) enhances care quality and patient safety. Nurses’ professional values promote ethical adherence, moral obligation fulfillment, and compliance to prevent ethical violations. It is necessary to explore the current status and influencing factors of moral courage from the perspective of professional values. Aim To investigate the current situation of nurses’ moral courage, analyze the latent profiles of nurses’ moral courage, and explore the influencing factors from the perspective of professional values. Research Design A cross-sectional design was (...) employed. Participants and research context Data were collected through convenient sampling at a tertiary hospital during May 2023 in Wuhan, Hubei province, China. A self-designed web-based questionnaire consisting of demographic characteristics, the Chinese Nurses’ Professional Values Scale-Revised Version (NPVS-R-CV) and the Nurses’ Moral Courage Scale (NMCS) were used for the cross-sectional survey. Latent profile analysis was conducted using the results of 3 explicit indexes of NMCS, and multivariate logistic regression was used to analyze the influencing factors of NMC. Ethical Considerations Research ethics approval (with the code of TJ- IRB 20220543) was obtained from Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology. Findings This study included 966 nurses, predominantly female and under 30 years old, with 91.10% holding a bachelor’s degree. Latent profile analysis identified three moral courage profiles: low-level (31.5%), medium-level (47.2%), and high-level (21.3%). Multivariate logistic regression analysis showed significant positive correlations between professional values and moral courage, with head nurses being significantly more likely to exhibit high moral courage (OR = 3.586, p = 0.013). Conclusions The moral courage of nurses can be classified into 3 subgroups. Nurses’ professional values positively correlate with moral courage, with head nurses showing significantly higher levels of moral courage. Strengthening professional values through training can enhance ethical behavior in nursing, potentially improving patient care and safety. (shrink)

Policy reforms implemented in Saudi Arabia in recent years aim to modernize the culture and infrastructure of healthcare delivery and are expected to integrate person‐ and patient‐centered care principles throughout the national healthcare system. However, in a complex multicultural environment where most nurses are international migrant workers, unique challenges emerge that frame the delivery of care. Better understanding is needed about what nurses perceive to be high‐quality, person‐centered care in Saudi Arabia and how they manage to enact it in practice. (...) Semi‐structured interviews were conducted with 21 nurses working in two tertiary hospitals in Riyadh, the capital city. Participants included Saudi citizens (n = 9) and expatriates (n = 12) who were asked to describe their perceptions of quality nursing care and explain the obstacles that they encounter in providing such care. Nurses reported extensive efforts to achieve individualized, empathetic, developmentally appropriate care. Their descriptions of care aligned with principles of patient‐centeredness in care but were not separable from challenges at the patient, organizational, and regional levels, including staffing and supplies shortages, gaps in regional care coordination, inadequate language translation services, variability in cultural beliefs about healthcare communication, and overt discrimination against expatriate workers. Nurses reported creative strategies to achieve professional nursing values while navigating a dynamic landscape of constraints. The findings add to literature suggesting that person‐centeredness in care cannot be understood outside the social and organizational conditions that shape it. (shrink)

Medical informed consent stands as an ethical and legal requisite preceding any medical intervention. Hospitalized patients face functional health literacy (FHL) challenges when dealing with informed consent forms (ICFs). The legitimacy of ICFs and informed consent procedures in China remains substantially undisclosed. The study’s aim was to investigate if Chinese patients have adequate FHL to be truly informed before providing medical consent. In this cross-sectional, structured interview-based study, FHL was assessed within the context of the informed consent scenarios in two (...) teaching hospitals (a 1500-bed general tertiary hospital and a 700-bed cancer hospital) affiliated with Shantou University Medical College. Twenty-seven patients admitted across clinical departments, along with their relatives (n = 59), were enrolled in the study after obtaining informed consent. The participants underwent a three-step assessment with two selected ICFs —teach-back skills, perceived understanding (perception), and informed knowledge (cognizance), with each component carrying a maximum score of 10. Data were analyzed with SPSS (version 22.0) for descriptive and inferential statistics, with consideration of significant P values as < 0.05. The median age (IQR and range) of participants was 35.5 (28 – 49 and 13 – 74) years. Most participants had only high school education (24.4%, 21/86) or below high school education (47.7%, 41/86). The median score (IQR) of FHL assessments—teach-back, perception, and cognizance—was 4.0 (2.5, 5.8), 8.0 (6.8, 8.8), and 6.5 (5.5, 8.0) out of 10, respectively. A moderate correlation was observed between the scores of cognizance and teach-back (r = 0.359, P = 0.002) or perception (r = 0.437, P < 0.001). Multivariate linear regression analysis predicted being a patient and having lower education levels as independent risk factors of inadequate FHL (Ps = 0.001). Lack of patient-centeredness in ICFs, time constraints, and poor clinical communication were identified as barriers impeding informed consent. This study demonstrates inadequacy in personal FHL and impaired organizational HL, resulting in compromised informed consent in Chinese teaching hospitals. As a remedy, we propose improving the quality of ICFs and institutionally mandated outcome-focused training on informed consent for all concerned clinicians to enhance medical ethics, ensure quality health care, address patient values, and mitigate potential medical conflicts. (shrink)

Sickle cell disease is a debilitating illness that affects quality of life and life expectancy for patients. In Cameroon, it is now possible to opt for termination of an affected pregnancy where the fetus is found to be affected by SCD. Our earlier studies found that, contrary to the views of Cameroonian physicians, a majority of parents with their children suffering from SCD would choose to abort if the fetuses were found to be affected. What have not yet been investigated (...) are the views of people suffering from/living with SCD. We used a quantitative sociological method, with administered structured questionnaires, to study the attitudes of adult patients suffering from SCD on prenatal genetic diagnosis and possible TAP. The majority of the 89 participants were urban dwellers , women , Christian and single , with a secondary/tertiary education . The majority would consider PND for SCD; almost half would reject TAP while 40.9% would consider it. Respondents who rejected TAP claimed mostly ethical reasons while those who found TAP acceptable cited fear of having an affected child and the poor quality of the affected child's health . Cameroonian patients with SCD are generally supportive of PND and a remarkably high number of patients living with SCD reported that they would consider terminating a pregnancy based on their assessment of the future well-being of the child. Research is required to investigate the burden of SCD on families and their quality of life. (shrink)