Background Nurses frequently face situations in their daily practice that are ethically difficult to handle and can lead to moral distress. Objective This study aimed to explore the phenomenon of moral distress and describe its work-related predictors and individual consequences for home-care nurses in Germany. Research design A cross-sectional design was employed. The moral distress scale and the COPSOQ III-questionnaire were used within the framework of an online survey conducted among home-care nurses in Germany. Frequency analyses, multiple linear and logistic (...) regressions, and Rasch analyses were performed. Participants and research context The invitation to participate was sent to every German home-care service ( n = 16,608). Ethical considerations The study was approved by the Data Protection Office and Ethics Committee of the German Federal Institute for Occupational Safety and Health. Results A total of 976 home-care nurses participated in this study. Job characteristics, such as high emotional demands, frequent work-life-conflicts, low influence at work, and low social support, were associated with higher disturbance caused by moral distress in home-care nurses. Organizational characteristics of home-care services, such as time margin with patients, predicted moral distress. High disturbance levels due to moral distress predicted higher burnout, worse state of health, and the intention to leave the job and the profession, but did not predict sickness absence. Conclusions To prevent home-care nurses from experiencing severe consequences of moral distress, adequate interventions should be developed. Home-care services ought to consider family friendly shifts, provide social support, such as opportunities for exchange within the team, and facilitate coping with emotional demands. Sufficient time for patient care must be scheduled and short-term takeover of unknown tours should be prevented. There is a need to develop and evaluate additional interventions aimed at reducing moral distress, specifically in the home-care nursing sector. (shrink)

Background Moral distress is a far-reaching problem for nurses in different settings as it threatens their health. Aim This study examined which situations lead to moral distress in home-care nursing, how and with which consequences home-care nurses experience moral distress, and how they cope with morally stressful situations and the resulting moral distress. Research design A qualitative interview study with reflexive thematic analysis was used. Participants and research context We conducted semi-structured interviews with 20 home-care nurses in Germany. Ethical considerations (...) The study was approved by the Data Protection Office and Ethics Committee of the German Federal Institute for Occupational Safety and Health. Findings Twenty (14 female and 6 male) home-care nurses were interviewed between April and August 2023 at their chosen location. The situations leading to moral distress were inadequate care of the person in need of care, not being able to protect one’s health, extended responsibility for the entire care arrangement, work–privacy conflicts, and conflicts between the understanding of care or professional ethics and the performance and billing system. The nurses experienced moral distress as they worked alone and provided care in the patient’s territory. Short- and long-term strains with destructive cognitions, negative emotions, physical symptoms, and health consequences were reported. They faced challenges in coping with moral distress on institutional and individual levels. Conclusions In cases of tension between the service and billing system and the understanding of these nurses’ care services, moral distress is unavoidable. Alternative forms of organization and billing modalities, such as payment by time and the expansion and refinancing of service, should be implemented. The latter relates to systematic case and ethics meetings. Further, a transfer of medical activities, such as the prescription of wound material to registered nurses, could prevent morally stressful situations and improve patients’ quality of care. (shrink)

Das Wort der "Genialität der Gerechtigkeit" stammt von Nietzsche selbst, der bekannte, dass er diese Form der Genialität mindestens ebenso hoch schätze wie alle übrigen. Gerade in den letzten Jahren seit Erscheinen der ersten Auflage ist die Problematik der Gerechtigkeit bei Nietzsche so stark in den Vordergrund gerückt wie lange nicht. Die Neuauflage unternimmt vor diesem Hintergrund den Versuch einer Neubewertung.

In lieu of an abstract, here is a brief excerpt of the content:A Changed Life: Becoming True to Who I amJay Kyle PetersenI was born intersex in 1952 in the county hospital of a very small, ultraconservative town in rural Southwestern Minnesota. My biological parents and paternal grandparents raised me on a small family farm nearby. I knew by age four I was a boy. No one told me. There was nothing to decide. I have always known I am male. (...) My parents never discussed my unusual condition with me and died having never accepted me. They denied my true identity and instead chose to give me a girl’s name and raise me as a girl.My paternal grandmother knew I was different. She lived on the farm with us and, as she explained to me later on in life, changed my diapers and helped take care of me as an infant and toddler. She also was a Certified Nurse’s Aide in the pediatric ward of the county hospital where I was born and could see that anatomically I was different from other infants. She remained my lifelong ally and friend until her death in 1993. She and Grandpa provided an oasis in their farmhouse where I felt accepted. I felt relaxed and comfortable in their company, and could just be myself. Grandpa took me fishing. Grandma drove me to 4–H State Fair demonstrations and supported me in the audience for which she had helped prepare me. My grandmother taught me good humor, excellence and how it was okay to make mistakes. Much later, in 1977, she drove four hours alone to Minneapolis in blizzard conditions to be my “concerned family person” during chemical dependency treatment, when my mother and dad refused and she also celebrated with me after my successful completion of the program. I loved her and she loved me and she showed it. With her I found refuge away from the pressure and abuse in our farmhouse.But my grandparents and parents did not show me affection physically. The only touch I felt from my family, except my paternal grandparents, was abusive including certain religious figures outside our family. Farm animals and pets provided warmth, love, acceptance, and companionship. I loved riding around the farm on the back of my pet pig, Lucy. Nature, especially trees, wild weather, and local lakes provided rest for my stretched, weary nerves and stimulation for my imagination. There was something about the vivid and contrasting colors, even the sounds and livingness about it all—rich deep moist greens, clean pure vast open blues, dark warm earth which I laid upon and felt in my hands. These and the soothing sounds of the wind gently moving through tree leaves and corn leaves and the lake water lapping calmly upon sandy shores, as Grandpa cast out his line: all this I found both relaxing and energizing and allowed for me the safety and environment to rest, let go and expand so my natural inclinations to express myself creatively could open up. Otherwise, I had a very lonely, frustrated, painful, humiliating childhood and adolescence filled with mounting anger and a sense of futility because I could not be or express my real male self—including my attraction to girls.The cultural and religious pressure I felt, the increased abuse and social lies I was forced to live with—including being forced to wear girls’ clothing against my will—became unbearable. I sought [End Page 106] refuge in addiction early on—food for comfort, nicotine for mood alteration, alcohol given to me by my dad, and more. I became suicidal, and remained for a long time terribly depressed.The geneticist I have consulted for the last four years says that physicians who examined me prior to my genital surgeries described my genitals as “male structures formed without enough testosterone,” rather than female structures formed in the presence of excess androgen. She told me that the features recorded in my medical records, and that she had observed, indicate androgen exposure in utero along with an inherited genetic condition such that she says my condition began at conception. I was born with XX karyotype and testing for usual causes for androgen excess with someone... (shrink)

Adam Smith war nicht nur einer der Begründer der Nationalökonomie, sondern auch Moralphilosoph, der in Vorlesungsmitschriften erhaltene Lectures on Jurisprudence hielt. Sein Vorhaben, eine umfassende Theorie des Rechts zu verfassen, konnte er nicht mehr verwirklichen und ließ von seinen Testamentsvollstreckern alle Entwürfe verbrennen. Die Hauptwerke enthalten aber so viele einschlägige Stellen, dass man sein rechtstheoretisches Konzept über weite Strecken rekonstruieren kann. Dabei ergeben sich buchstäblich brandaktuelleEinsichten: Seinen Vorschlag eines die Freiheit der Individuen einschränkenden Bankengesetzes etwa verglich er mit der Pflicht (...) zum Bau einer gemeinsamen Brandmauer - ein angesichts des weltweiten Flächenbrandes, den die jüngste Bankenkrise angerichtet hat, hochmodernes Bild. (shrink)

Indem Montaigne die Jurisprudenz von Grund auf anzweifelte, hat er ihr zugleich die Grundlagen des Rechts in einer spezifisch neuzeitlichen Weise erschlossen. Das Buch versucht zu zeigen, dass Montaignes Zweifel am Naturrecht und der juristischen Methode nicht nur zu einem neuen Verständnis der Rechtsphilosophie führte, sondern auch die Rechtsgeschichte umfassend würdigte, die rechtsökonomischen Gegebenheiten betrachtete und der Rechtssoziologie und Rechtsanthropologie den Weg ebnete. Obwohl er nichts weniger suchte, entdeckte Montaigne beiläufig die Grundlagen des Rechts in ihrer Gesamtheit.

Astonishingly, despite the vast amount of scholarship on Machiavelli, no study exists on his theory of legislation, which runs through his celebrated work The Prince, the three-volume Discourses on Livy, the History of Florence, and many of his shorter writings. Jens Petersen's work fills this gap and applies his insights to contemporary legislation.

Wahrend uber Max Webers Religionssoziologie ganze Bibliotheken geschrieben worden sind, gibt es zu seiner Rechtssoziologie - ungeachtet ihrer von Talcott Parsons herausgestellten Zentralitat in Webers Werk - vergleichsweise wenige Bande. Insbesondere ist sein Verhaltnis zur juristischen Methodenlehre nahezu unberucksichtigt geblieben, obwohl er als promovierter und habilitierter Jurist im weitesten Sinne von ihr ausgegangen ist. Max Webers Rechtssoziologie ist fur die Rechtsdogmatik nicht zuletzt deshalb so interessant, weil Weber das Recht und die juristische Methode inwendig kannte und von daher deutend verstehen (...) konnte. ". (shrink)

Blaise Pascal (1623-1662) gehort zu den grossten Geistern, die je auf Erden gelebt haben. Der vorliegende Band versucht eine Verbindungslinie zwischen seiner Rechtsphilosophie und seiner Religionsphilosophie herzustellen, indem er Pascals Gedanken uber die Gerechtigkeit zu seiner beruhmten Lehre von den drei Ordnungen ins Verhaltnis setzt. ".

Das Buch zeichnet Schopenhauers individualistisches Rechtsdenken nach und verteidigt seinen methodischen Individualismus namentlich gegen Carl Schmitt. Soweit ersichtlich erstmals wird Schopenhauers Idee der ewigen Gerechtigkeit der Kritik Friedrich Nietzsches gegenübergestellt.

Giambattista Vico gilt als Begründer der Kulturwissenschaft, obwohl er Jurist war und Rhetorik lehrte. Der Autor führt die juristische Provenienz mit Vicos kulturgeschichtlichen Entdeckungen zusammen und begründet diese in Verbindung mit jener. Durch diese Rückbesinnung auf Vicos Theorie kann womöglich auch die Rechtswissenschaft als Kulturwissenschaft begriffen werden.

Wilhelm von Humboldts Rechtsphilosophie ist bei weitem nicht so bekannt wie seine Sprachphilosophie oder gar seine Rolle als Bildungsreformer. Der Autor untersucht zu diesem Zweck Humboldts "Ideen zu einem Versuch, die Grenzen der Wirksamkeit des Staates zu bestimmen".