Background: Most previous studies on moral distress focused on the factors that cause moral distress, paying inadequate attention to the moral conflict of nurses’ values, the physician–nurse power hierarchy, and the influence of the culture. Research objective: To analyze the main causes for moral distress with interpretive interactionism. Research design: A qualitative study was adopted. Participants: Through purposeful sampling, 32 nurses from 12 different departments were chosen as the samples. Ethical considerations: Approval from the Institutional Review Board of the Kaohsiung (...) Medical University Hospital. Findings: Moral distress is likely to occur in the following clinical situations: patients have no idea about their diseases; the medical decisions fail to meet the optimum benefit of patients; and patients with terminal cancers are not given a proper death. The reason why nurses become trapped in moral distress is that they fail to achieve moral goodness. Inadequate confidence, the physician–nurse power hierarchy, and the Oriental culture affect nurses’ goodness-based intention for patients, which deteriorates moral distress. Discussion: The main cause for moral distress is the moral goodness of nurses. If nurses’ goodness-based intention for patients is inconsistent with the moral objective of achieving optimum benefit for patients, it leads to moral distress. Culture is an essential background factor of care for patients. In the Oriental culture, family members influence patients’ right to know about their diseases, the choice of treatment, and patients’ autonomy of not receiving cardio-pulmonary resuscitation. This results in moral distress in medical care. Conclusion: The occurrence of moral distress demonstrates that nurses have moral characteristics such as goodness and caring. It is suggested that appropriate educational strategies can be adopted to weaken the power hierarchy between physicians and nurses and enhance nurses’ confidence and cultural sensitivity, so as to reduce the moral distress of nurses. (shrink)

Background: As moral action could help nurses reduce moral distress, it is necessary to carry out qualitative research to present the experiences in which nurses apply moral action. Aim: To describe and analyze the phronesis applied by nurses in the face of moral distress. Research design: The research participants were invited to participate in in-depth interviews. The research materials were based on the stories described by the research participants and recorded by means of first-person narrative. Narrative analysis was applied to (...) interpret the nurses’ phronesis. Participants: Twenty-seven nurses from Taiwan. Ethical considerations: The Institutional Review Board of the Kaohsiung Medical University Hospital in Taiwan confirmed that this study passed the research ethical review. Findings: According to the narrative analysis results, the phenomenon of moral distress contains difficulty, action, and idea transformation. The difficulty is the source of moral distress, action is the practice of moral courage, and idea transformation is the nurse’s emotional movement. Action and idea transformation are collectively called phronesis in this study. Discussion: Moral distress refers to a state of suffering caused by situations in which nurses cannot carry out their ethical intentions. Phronesis is the process through which nurses take actions and relocate the subjects and is an ethical way to find relief from moral distress. Starting with empathy and respectful attitudes arising from self-reflection, nurses may be helped to get relief from the suffering of moral distress. Conclusion: Phronesis can help nurses positively face the emotional strain of moral distress. This article puts forward a narrative method to complete the four steps of phronesis: write about the care experience, identify the difficulties in the stories, seek the possibility of action, and form a new care attitude, which could help nurses learn to reduce their moral distress. (shrink)

Background The Constitutional Court of South Korea declared that an abortion ban was unconstitutional on April 11, 2019. The National Health Care System will provide abortion care across the country as a formal medical service. Conscientious objection is an issue raised during the construction of legal reforms. Methods One hundred sixty-seven perioperative nurses responded to the survey questionnaire. Nurses’ perception about conscientious objection, support of legislation regarding conscientious objection, and intention to object were measured. Logistic regression was used to explore (...) the factors associated with support of the legislation and the intention to conscientiously object. Results Only 28.8% of the responding nurses were aware of health care professionals’ conscientious objection. The majority felt that patients’ rights should be prioritized over health care professionals’ conscientious objection. On the other hand, 45.8% supported the legislation on conscientious objection to abortion, and 42.5% indicated a willingness to refuse to participate in an abortion case if conscientious objection was permitted. Religion, awareness of conscientious objection, and prioritizing of nurses’ right to conscientious objection were significantly associated with supporting the legislation. Moreover, religion and prioritizing nurses' rights were significantly associated with the intention to conscientiously object. Conclusions This study provides information necessary for further discussion of nurses’ conscientious objection. Nursing leaders, researchers, and educators should appeal to nurses and involve them in making policies that balance a women's right to non-discrimination and to receiving appropriate care with nurses' rights to maintain their moral integrity without compromising their professional obligation. (shrink)

성호 이익의 저서 『성호사설』의 글 중에서 저자 성호 선생의 사유와 생애를 뚜렷이 보여주는 작품만을 선별하여 구성하였다. 『성호사설』에 수록된 글들은 성호가 40세 전후부터 평소에 공부하거나 생활하거나 제자들을 가르치다가 떠오른 생각이나 의문들을 적어둔 것들이다. 성호는 그 글들을 차곡차곡 모아두었다가 나이가 80세에 가까워지자 그 글들을 꺼내어 정리했다. 40여년에 걸친 학문의 총 결산이 곧 『성호사설』인 것이다. 여기에서‘사설’은 한자로 僿說로 ‘자질구레한 논설’이라는 뜻이다. 『성호사설』은 폭넓은 지식을 담고 있다는 점에서는 백과사전과 비슷하지만 그와 결정적으로 구분되는 점은 실학자로서의 ‘투철한 문제의식’과 ‘높은 식견’을 보여준다. 『성호사설』에 담긴 광범위한 지식은 그저 (...) 흥밋거리나 ‘지식을 위한 지식’으로 나열된 것이 아니다. 어떻게 하면 하층민이 더 잘살 수 있을까, 열심히 일하는 사람이 더 가난해지고 놀고먹는 자들이 특권을 유지하는 부조리를 어떻게 하면 청산할 수 있을까, 어떻게 하면 부당하게 잊힌 사람들이 정당한 평가를 받게 할 수 있을까 등의 질문에 답하며 문제를 구체적이면서도 치밀하고 깊이 있게 파고들기 위한 지식인 것이다. (shrink)

수사학과 화용론의 만남이라눈 부제롤 달고 인간의 의사전달 체계인 언어의 문법구조를 집중 분석한 연구서.

수사학과 화용론의 만남이라눈 부제롤 달고 인간의 의사전달 체계인 언어의 문법구조를 집중 분석한 연구서.

오늘날의 현실을 구조로 쌓기 전에 해체를 주장하고 모더니즘에 이르기전에 '포스트'를 제창하는 혼란의 시대라고 판단하며 그 철학적 대안을 제시한 현직 교수의 저술.

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