Moral distress has been characterised as one of the main ethical problems affecting nurses in all health systems, and has been depicted as a threat to nurses’ integrity and to the quality of patient care. In recent years, several studies tried to investigate moral distress, its causes and consequences for health professionals, clients and organisations. However, such studies are considered controversial and vulnerable, mainly because they lack a solid philosophical and empirical basis. The present article aimed at elaborating a theoretical (...) model for moral distress, considering the process of moral deliberation, spaces of power and resistance and patient advocacy, and sought to carry out a reflection that culminated with the creation of a broader concept of moral distress. (shrink)

Background Moral distress is a phenomenon that can lead to an imbalance of the mind and body. There are many coping strategies to overcome the obstacles that lead the subject to this condition. Some coping strategies are capable of being achieved through the cultivation of moral resilience. Aim The aim is to identify the strategies of moral resilience in the nursing management of University Hospitals in Brazil. Research design The research design is the qualitative study with discursive textual analysis. Participants (...) and research context : 44 nurse managers and nurses in leadership positions participated in a total of 30 University Hospitals in Brazil. Data were collected online, using a questionnaire with open questions. Ethical considerations The Ethics Committee approved the study. Participants received information about the research, agreed to respond to the questionnaire, and were guaranteed anonymity. Findings Personal adaptive strategies (intrapersonal and interpersonal) and organizational collaborative strategies (intrinsic and transformational management) emerged from this process. The intrapersonal strategies involved elements of rationality, flexibility, rebalancing practices, moral courage, and detachment. The interpersonal strategies addressed support networks, team involvement, and dialog. Organizational strategies dealt with actions which reorient ethical infrastructure, ethical education, and psychological protection, as well as fostering dialogical relationships, empowerment, and cooperation. Conclusion From the perspective of social historical construction, it is understood that developing personal and organizational strategies is essential to cultivating moral resilience. (shrink)

The ethical climate is the perception of health professionals about the work environment, meaning the reflection on care practices and ethical-related decisions. There are extensive studies in the international literature about the ethical climate, but there are still theoretical gaps about it in health services. In this reflection article, the objective was to explore conceptual components about the ethical climate, proposing new elements of analysis of the construct. The starting point was the accumulated knowledge itself, the possibilities for expansion, and (...) the conceptual progress emerging from contributions from studies on nursing ethics. It was understandable that the ethical climate is considered in its procedural model and cyclically, being articulated with organizational elements, as established in the literature, and, expanding the concept, with the worker’s health and the ethical expressiveness at work. Regarding this last contribution, the suggestion is to think about the potential for work to allow, limit, or favor professionals to express their ethical and esthetic values in the most daily decisions and relationships, in care, management, and education. The conceptual framework of this study progressed by addressing the ethical climate as a process articulating several concepts and elements regarding the organizational aspect, ethics, and the workers’ well-being. (shrink)

Introduction: During their education process, nursing undergraduates experience ethical conflicts and dilemmas that can lead to moral distress. Moral distress can deprive the undergraduates of their working potential and may cause physical and mental health problems. Objective: We investigated the experiences of the undergraduates in order to identify the existence of moral distress caused by ethical conflict and dilemmas experienced during their nursing education. Ethical considerations: This study was designed according to the principles of research with human beings and was (...) approved by the Human Research Ethics Committee. Method: A qualitative multiple-case study. Two federal higher education institutions were surveyed, from which 58 undergraduates in nursing participated in the study. The undergraduates were undergoing their professional training. The data were collected through focus groups and were submitted to thematic content analysis, with the resources of the ATLAS TI 7.0 software. Results: Moral distress in undergraduates is a reality and was identified in three axes of analysis: (1) moral distress is experienced by undergraduates in the reality of healthcare services, (2) the teacher as a source of moral distress, and (3) moral distress as a positive experience. Conclusion: The undergraduates in nursing manifest moral distress in different stages of their education, particularly during their professional training. The academic community should reflect and seek solutions for the reality of moral distress in undergraduates. (shrink)

This theoretical paper proposes a new perspective to understand the moral distress of nurses more fully, using virtue ethics. Moral distress is a widely studied subject, especially with respect to the determination of its causes and manifestations. Increasing the theoretical depth of previous work using ethical theory, however, can create new possibilities for moral distress to be explored and analyzed. Drawing on more recent work in this field, we explicate the conceptual framework of the process of moral distress in nurses, (...) proposed by Ramos et al., using MacIntyrean virtue ethics. Our analysis considers the experience of moral distress in the context of a practice, enabling the adaptation of this framework using virtue ethics. The adoption of virtue ethics as an ethical perspective broadens the understanding of the complexity of nurses’ experiences of moral distress, since it is impossible to create a ready model that can cover all possibilities. Specifically, we describe how identity, social context, beliefs, and tradition shape moral discomfort, uncertainty, and sensitivity and how virtues inform moral judgments. Individuals, such as nurses, who are involved in a practice have a narrative history and a purpose ( telos) that guide them in every step of the process, especially in moral judgment. It is worth emphasizing that the process described is supported by the formation of moral competence that, if blocked, can lead to moral distress and deprofessionalization. It is expected that nurses seek to achieve the internal good of their practice, which legitimizes their professional practice and supports them in moral decision-making, preventing moral distress. (shrink)

This article documents our collaborative ongoing struggle to disrupt the reproduction of the coloniality of knowledge in the teaching of Gender Studies. We document how our decolonial feminist activism is actualised in our pedagogy, which is guided by feminist interpretations of ‘wonder’ (Irigaray, 1999; Ahmed, 2004; hooks, 2010) read alongside decolonial theory, including that of Ramón Grosfoguel, Walter D. Mignolo and María Lugones. Using notions of wonder as pedagogy, we attempt to create spaces in our classrooms where critical self-reflection and (...) critical intellectual and embodied engagement can emerge. Our attempts to create these spaces include multiple aspects or threads that, when woven together, might enable other ways of knowing-being-doing that works towards disrupting feminist complicity with coloniality in the Australian context. (shrink)

This paper aims to offer an image of Nietzsche as a reader of Schopenhauer, putting aside some fundamental issues, such as the influence of Wagner and the critique of his former master in his late philosophy. Trying to isolate these aspects, I will take Nietzsche as one of the most important reader of Schopenhauer. His deep veneration does not exclude relentless criticism and his relentless criticism does not exclude his deep veneration of Schopenhauer.

Background: Nursing students on clinical placements as part of their professional training are routinely faced with situations involving ethical conflicts. The initial act of perceiving a situation as causing an ethical dilemma is the result of both the students’ personal values, drawn from their culture and families, and of the professional knowledge and values that they have acquired through training and experience. Objectives: Nursing students’ experiences on clinical placements in primary care settings were investigated in order to identify situations that (...) they perceived as involving ethical conflict and describe the elements they took into consideration during their decision-making processes in these situations. Methods: The research design was qualitative descriptive case study. Around 50 students from three different intakes to a nursing degree answered a questionnaire and discussed it in focus groups. Ethical considerations: The study was designed in accordance with the principles guiding research with human beings and was approved by the Human Research Ethics Committee. Results: Synthesised into two principal axes: (a) ethical conflicts in primary care, linked with the domains of working processes, professional nursing ethics and human and social rights and (b) students’ decision-making processes – realisation, reflection and intervention. Conclusion: The student nurses saw themselves both as actors and spectators in situations involving ethical problems and demanding moral deliberation, demonstrating the ability to base their arguments soundly. They tended to emphasise the possibilities offered by dialogue and that different ethical values must be respected to find fair solutions to ethical problems. (shrink)

Background: Moral distress is considered to be the negative feelings that arise when one knows the morally correct response to a situation but cannot act because of institutional or hierarchal constraints. Objectives: To analyze moral distress and its relation with sociodemographic and academic variables in undergraduate students from different universities in Brazil. Method: Quantitative study with a cross-sectional design. Data were collected through the Moral Distress Scale for Nursing Students, with 499 nursing students from three universities in the extreme south (...) of Brazil answering the scale. The data were analyzed in the statistical software SPSS version 22.0, through descriptive statistical analysis, association tests (t-test and analysis of variance), and linear regression models. Ethical considerations: Approval for the study was obtained from the Research Ethics Committee at Universidade Federal do Rio Grande. Findings: The mean intensity of moral distress in the constructs ranged from 1.60 to 2.55. As to the occurrence of situations leading to moral distress in the constructs, the frequencies ranged from 1.21 to 2.43. The intensity level of moral distress showed higher averages in the more advanced grades of the undergraduate nursing course, when compared to the early grades of this course (between 5 and 10 grade, average = 2.60–3.14, p = 0.000). Conclusion: The demographic and academic characteristics of the undergraduate nursing students who referred higher levels of moral distress were being enrolled in the final course semesters, were at a federal university, and had no prior degree as an auxiliary nurse/nursing technician. (shrink)

One of the objectives in the field of artificial intelligence for some decades has been the development of artificial agents capable of coexisting in harmony with people and other systems. The computing research community has made efforts to design artificial agents capable of doing tasks the way people do, tasks requiring cognitive mechanisms such as planning, decision-making, and learning. The application domains of such software agents are evident nowadays. Humans are experiencing the inclusion of artificial agents in their environment as (...) unmanned vehicles, intelligent houses, and humanoid robots capable of caring for people. In this context, research in the field of machine ethics has become more than a hot topic. Machine ethics focuses on developing ethical mechanisms for artificial agents to be capable of engaging in moral behavior. However, there are still crucial challenges in the development of truly Artificial Moral Agents. This paper aims to show the current status of Artificial Moral Agents by analyzing models proposed over the past two decades. As a result of this review, a taxonomy to classify Artificial Moral Agents according to the strategies and criteria used to deal with ethical problems is proposed. The presented review aims to illustrate (1) the complexity of designing and developing ethical mechanisms for this type of agent, and (2) that there is a long way to go (from a technological perspective) before this type of artificial agent can replace human judgment in difficult, surprising or ambiguous moral situations. (shrink)

Building on a functionalist framework for decision-making in legal translation, a holistic approach to quality is presented in order to respond to the specificities of this field and overcome the shortcomings of general models of translation quality evaluation. The proposed approach connects legal, contextual, macrotextual and microtextual variables for the definition of the translation adequacy strategy, which guides problem-solving and the rest of the translation process. The same parameters remain traceable between the translation brief and the translation product both in (...) pre-delivery revision and in post-delivery assessment. They are the yardstick for identifying predictable evaluative criteria and competence requirements for translators and quality controllers. The implications of the approach on quality assessment and quality management practices are also discussed. Overall, the model illustrates the potential benefits of enhancing predictability and reducing subjectivity on the basis of specific legal translation methodologies. It supports the need for legal translation expertise in quality evaluation and the relevance of Legal Translation Studies to raising standards in professional practice. (shrink)

In this work we define, in a general way, an algebraic semantics for the logics of the hierarchy InPk. This semantics is defined by means of an alternative construction, with respect to the usual algebraic semantics, and it is known in the literature as Twist-structures semantics. Besides that, we modify such construction, defining the so-called ω-Twist-structures here. This adaptation allows us to prove adequacy theorems for every logic of the hierarchy InPk.

A qualitative study with an exploratory, descriptive and documentary design that was conducted with the objective of identifying the elements to constitute a method for the analysis of accusations of and proceedings for professional ethics infringements. The method is based on underlying elements identified inductively during analysis of professional ethics hearings judged by and filed in the archives of the Regional Nursing Board of Santa Catarina, Brazil, between 1999 and 2007. The strategies developed were based on the results of an (...) analysis of the findings of fact (occurrences/infractions, causes and outcomes) contained in the records of 128 professional ethics hearings and on the structural elements (statements, rules and practices) identified in five example professional ethics cases. The strategies suggested for evaluating accusations of ethics infringements and the procedures involved in deliberating on ethics hearings constitute a generic proposal that will require adaptation to the context of specific professional ethics accusations. (shrink)

A qualitative study with an exploratory, descriptive and documentary design that was conducted with the objective of identifying the elements to constitute a method for the analysis of accusations of and proceedings for professional ethics infringements. The method is based on underlying elements identified inductively during analysis of professional ethics hearings judged by and filed in the archives of the Regional Nursing Board of Santa Catarina, Brazil, between 1999 and 2007. The strategies developed were based on the results of an (...) analysis of the findings of fact (occurrences/infractions, causes and outcomes) contained in the records of 128 professional ethics hearings and on the structural elements (statements, rules and practices) identified in five example professional ethics cases. The strategies suggested for evaluating accusations of ethics infringements and the procedures involved in deliberating on ethics hearings constitute a generic proposal that will require adaptation to the context of specific professional ethics accusations. (shrink)

Como é bem conhecido, Josef Pieper não se identificava como um tomista, embora a sua obra tenha sido muito influenciada pelo pensamento de Tomás de Aquino. De fato, Pieper é considerado um dos maiores tomistas do século XX. Embora Pieper trate brevemente e de maneira muito específica sobre a atualidade do tomismo numa obra, é preciso averiguar o seu conjunto para esclarecer o presente tópico. Seguindo a própria metodologia do autor, isto é, o uso de pequenas questões e perguntas, os (...) subtítulos são sempre interrogativos, começando sobre a questão acerca do próprio tema, o significado da “atualidade” e do “tomismo” até chegar ao cerne do debate, isto é, o tomismo hoje em dia. (shrink)

Background Education is a tool for the promotion of ethical skills that ensure the principles of conduct and the quality of care provided. The literature is still incipient in this theme; however, some studies point to education and ethical consultations as strategies to promote an ethical environment. Objective To map the interventions that aim to prospect the ethical environment in health services. Method Scoping review to answer the question “What interventions are being used by health professionals to prospect an ethical (...) environment in health services?” It occurred in the Medline (PubMed), CINAHL with Full Text (EBSCO), Scopus, Embase (Elsevier), and Web of Science databases in January 2023 by two reviewers, via the Rayyan platform. Articles with health professionals addressing interventions to prospect the ethical environment in any health service were included, without time frame. A form was used for data extraction and analysis occurred via Bardin content analysis. The review protocol was registered in the Open Science Framework. Results 2429 records were found; however, only 12 articles were included for analysis, these being randomized, cross-sectional, descriptive, and qualitative studies. Among the interventions, it was noticed that 58.3% ( n = 7) is about ethical education, 16.7% ( n = 2) about ethical guidelines and codes, 16.7% ( n = 2) about ethical reflection and leadership, and 8.3% ( n = 1) of ethical consultations. A theoretical map was elaborated, and four types of interventions were identified, based on ethical consultation, ethical education, guidelines and codes of ethics, reflection, and ethical leadership. Conclusions The interventions were considered effective to prospect the ethical environment in health services, and their effectiveness was evaluated by validated instruments, as well as through interviews and focus groups. (shrink)

To identify how digital media are being used by community-led initiatives of the Centro Region of Portugal, and to identify the requirements that a digital platform for mediation between agents in the territory should have, two focus groups were conducted, involving six small-sized community-led initiatives and six larger-sized community-led initiatives. This article details the results of these focus groups, according to the following main categories: use of existing communication and mediation tools; the purpose of use of digital tools; type of (...) experiences prompted by digital tools and attributes and features desired in a digital platform to support community-led initiatives. The results show differences between the use and needs of digital tools by small- and larger-sized initiatives and offer interesting insights to prototype an innovative digital solution, to enhance the actions of community-led initiatives. A reference framework for digital mediation strategies and a mobile app prototype were developed, based on these surveys. The article contributes with an analytical view about the development of digital solutions, which aim to strengthen the relationship among agents of local communities and promote mediation mechanisms among all stakeholders in territorial-based innovation. (shrink)

This study aimed to understand the expressions of fear in the journeys of health professionals who worked in the confrontation of coronavirus disease 2019 (COVID‐19), in the city of Manaus, in the Brazilian Western Amazon. This is an exploratory qualitative study that adopts interpretive description as a method to generate informed knowledge responsive to the needs of the practice. We included 56 participants, comprising 23 health managers and 33 health workers (middle and higher level) of different professional categories. The results (...) revealed three circles of experience: (1) knowledge and professional experience in dealing with the disease (unknown–known–experienced); (2) the growing proximity to death and loss (predicted–witnessed–suffered); and (3) the involvement and proximity to whatever affects the individual, their emotions, and personal transformations in the face of the threat (the collective, the neighbor, and oneself). Our results suggest that health professionals who worked during the COVID‐19 pandemic in Manaus experienced insecurity, dread, and fear, illustrating the complexity of developing their activities in the front line of care and management during the different phases of the pandemic. A contribution of the study is precisely that of capturing this complexity, which suggests the impossibility of analyzing fear only in its simple manifestation, or in each circle of experience. (shrink)

Entendemos que promover a qualidade na educação para crianças pequenas é uma das metas da Educação Básica brasileira e que, nesse sentido, há ainda muito por fazer no cenário nacional. Desse modo, busca-se inspiração na experiência de décadas do trabalho nos serviços educativos com crianças pequenas na Itália para pensar peculiaridades da etapa Educação Infantil que contribuam para qualificá-la. Assim, este artigo propõe-se a discutir aspectos relacionados à qualidade dos serviços educativos destinados a crianças pequenas na Itália. Para analisar a (...) questão posta, apoiamo-nos em Galardini e Malaguzzi. O estudo segue delineamento qualitativo e parte da observação de serviços educacionais na cidade de Pistóia, região da Toscana, na Itália, durante período de estágio de doutoramento no ano de 2018. Dessa observação, emergem categorias que serão problematizadas: a formação do professor que atua com crianças pequenas, o papel do coordenador pedagógico nas escolas e, por fim, a relevância do espaço, seja interno ou externo, como um princípio educativo. Aponta-se como resultados que qualificar o espaço nos serviços educativos significa construir um ambiente bem dimensionado e articulado às demandas infantis e que o coordenador pedagógico e os educadores são profissionais fundamentais para garantir a qualidade nos serviços ofertados. (shrink)

O presente artigo analisa duas correntes de crítica à religião em âmbito filosófico, características da segunda metade do século XX. Primeiramente, a perspectiva do filósofo francês e ex-professor da Sorbonne e de Nanterre, Jean-François Lyotard (1924-1998). Em segundo lugar, as posições inspiradas nos slogans da revolução de Maio de 68. Por fim, procura-se evidenciar as raízes, singularidades e semelhanças entre as duas posturas. /// This article analyzes two currents of religious critique in the philosophical ambit, characteristic of the second half (...) of the twentieth century. In the first place, the outlook of French philosopher and ex-professor of the Sorbonne and the Nanterre, Jean-François Lyotard (1924-1998), and secondly, the positions inspired by the slogans of the revolution of May ’68. Finally, the article seeks to manifest the roots, singularities and similarities between the two stances. (shrink)

This article examines the third objection of Chapter Five of the opusculum De unitate intellectus of Saint Thomas. This section offers a summary of Thomist gnoseology and the most important arguments regarding the unity of the intellect. It also represents a true milestone in Western Philosophy, by specifying the object of intellection and the distinction between id quod intelligitur and in quo intelligitur, fundamental themes in the context of moderate realism in comparison with the other currents of the theory of (...) knowledge. (shrink)

A relação entre os quatro livros de O mundo como Vontade e Representação, isto é, entre as quatro partes da filosofia de Schopenhauer, tem sido uma das questões mais controversas da pesquisa sobre seu pensamento. Saber se a ética é de fato mais importante que a estética, ou se a metafísica deve ser subordinada à teoria do conhecimento, são questões que têm ocupado frequentemente os intérpretes do filósofo. Há diversas interpretações rivais sobre o modo como a filosofia de Schopenhauer deve (...) ser lida, se como um sistema arquitetônico e linear, ou orgânico e sem subordinação de uma parte à outra, por exemplo. As afirmações do próprio autor sobre o estatuto de sua filosofia nem sempre são suficientes para dirimir as controvérsias. No presente artigo, procurarei reconstruir algumas dessas leituras e propor uma interpretação própria para o que entendo ser o sistema filosófico de Schopenhauer. (shrink)

Resumo: A honra foi amplamente tratada por diversos autores antigos, tais como Aristóteles e Cícero. No medievo, Tomás de Aquino retoma alguns temas da Antiguidade, oferecendo uma formulação nova. Para isso, ele se serve do conceito de dulia, superando o tradicional binômio com a latria. Na realidade, ele reputa à dulia uma virtude anexa à justiça que visa prestar honras ou homenagens aos homens excelentes, em particular aos virtuosos. De fato, o Estagirita já considerava a honra como um “prêmio da (...) virtude”. Nesse contexto, se percorre todo corpus thomisticum para analisar o conceito de dulia e de honra, quando esta se refere ao assunto tratado. Para isso, se pergunta o que é a dulia propriamente, a quem deve ela ser prestada, se a honra pode ou deve ser desejada, o papel da magnanimidade, como e para que se honra. A proposta tomasiana poderia trazer um novo olhar a respeito da temática, infelizmente um pouco esquecida nos dias de hoje.: Honor was amply dealt with by several ancient authors such as Aristotle and Cicero. In the Middle Ages, Thomas Aquinas revisited certain themes from Antiquity, offering new formulations. To do this, he used the concept of dulia, going beyond the traditional contrast with latria. He regards dulia as a virtue connected to justice and that seeks to pay honour or homage to excellent men, particularly virtuous ones. In fact, Aristotle already regarded honour as a “reward for virtue”. In this article, the body of Thomistic work is explored in order to analyse the concept of dulia and honour. To this end, it is asked what dulia truly is, to whom it should be rendered, whether honour can or should be desired, what the role of magnanimity is, and how honour should be shown and for what. The Thomistic proposal offers a new outlook on a subject which, unfortunately, has been somewhat neglected in the present day. (shrink)

"Do I believe to understand or do I understand to believe? From an analysis of chapters II and III of Fides et ratio, and the texts of St. Thomas Aquinas, an analysis is sought that aims to offer a response that reconciles these two ambits within an anthropological perspective.".

No anseio de compreender a verdade divina, Santo Anselmo, em seu Proslogion, desenvolve o célebre unum argumentum a respeito da existência de Deus. Na segunda parte da obra, ao expressar-se sobre os atributos divinos e sobre as antinomias que se lhe apresentam, o Doutor Magnífico surpreende o leitor com a revelação de que Deus é summe sensibilis — sumamente sensível. Parte-se então de duas visualizações: a possibilidade de Deus ser sensível em si mesmo (secundum se), ou em relação a nós (...) (secundum nos); isto é, da possibilidade de Deus sentir, embora carecendo de sentidos, e da possibilidade de O sentirmos, sendo Ele incorpóreo. Por fim, o artigo focaliza a questão de Deus ser sensível através das criaturas e da reconfiguração da sensibilidade humana no encontro com o Sumo Ser na bem-aventurança. /// "With the desire to understand divine truth, Saint Anselm, in his Proslogion, develops his celebrated unum argumentum with respect to the existence of God. In the second part of the work, in discussing the divine attributes and the antinomies that appear, the Magnificent Doctor surprises the reader with the revelation that God is summe sensibilis — supremely sensible. This is broken down into two visualizations: the possibility of God being sensible in Himself (secundum se), or in relation to us (secundum nos); that is, the possibility of God sensing, despite lacking senses, and our possibility of sensing Him, He being incorporeal. Finally, the article focuses on the question of God being sensible through creatures and the reconfiguration of human sensibility in the encounter with the Supreme Being in blessedness.". (shrink)