Background There is ongoing debate regarding how moral distress should be defined. Some scholars argue that the standard “narrow” definition overlooks morally relevant causes of distress, while others argue that broadening the definition of moral distress risks making measurement impractical. However, without measurement, the true extent of moral distress remains unknown. Research aims To explore the frequency and intensity of five sub-categorizations of moral distress, resources used, intention to leave, and turnover of nurses using a new survey instrument. Research design (...) A mixed methods embedded design included a longitudinal, descriptive investigator-developed electronic survey with open-ended questions sent twice a week for 6 weeks. Analysis included descriptive and comparative statistics and content analysis of narrative data. Participants Registered nurses from four hospitals within one large healthcare system in Midwest United States. Ethical considerations IRB approval was obtained. Results 246 participants completed the baseline survey, 80 participants provided data longitudinally for a minimum of 3 data points. At baseline, moral-conflict distress occurred with the highest frequency, followed by moral-constraint distress and moral-tension distress. By intensity, the most distressing sub-category was moral-tension distress, followed by “other” distress and moral-constraint distress. Longitudinally, when ranked by frequency, nurses experienced moral-conflict distress, moral-constraint distress, and moral-tension distress; by intensity, scores were highest for moral-tension distress, moral-uncertainty distress, and moral-constraint distress. Of available resources, participants spoke with colleagues and senior colleagues more frequently than using consultative services such as ethics consultation. Conclusions Nurses experienced distress related to a number of moral issues extending beyond the traditional understanding of moral distress (as occurring due to a constraint) suggesting that our understanding and measurement of moral distress should be broadened. Nurses frequently used peer support as their primary resource but it was only moderately helpful. Effective peer support for moral distress could be impactful. Future research on moral distress sub-categories is needed. (shrink)

This Is A New Release Of The Original 1909 Edition.

Background: Pre-licensure ethics nursing education does not adequately prepare and instill confidence in nurses to address ethical issues, and yet ethics education provides nurses with greater confidence to take moral action, which can mitigate the negative effects of moral distress. Objectives: To assess the feasibility and acceptability of a nursing ethics education program that included simulated case-based ethics competencies as a form of evaluation. The program aimed at building nurses’ ethical knowledge and confidence to respond to ethical challenges in practice. (...) Research design: A prospective, longitudinal, correlational, single-cohort feasibility study using an investigator-developed survey and intervention field data. Participants and research context: Registered nurses were recruited from an academic quaternary-care medical center and 9 small- to mid-sized regional hospitals within one health system in the Midwest United States. Ethical considerations: IRB approval was obtained. Participants could complete the educational program regardless of research process participation. Findings: Of 20 participants, 19 (95%) provided post-program surveys and 18 completed competencies. Median (IQR) scores with quartiles for scheduling, timing, and length of sessions were all 10.0 [9.0, 10.0], and participants perceived that the content was interesting, increased knowledge and confidence in ethics, increased skills in providing ethical care, and would recommend the program to colleagues. Of factors, an increase in ethics knowledge had the highest “always agree” (17, 89.5%) response. Most participants reported that ethics competencies were appropriate 9.0 [9.0, 10.0] and sufficiently challenging 10.0 [9.0, 10.0]. Discussion: The education program developed nurses’ ethics knowledge and confidence. The single-cohort feasibility design provided early-stage intervention outcomes; however, a larger randomized controlled trial would substantiate program value. Conclusion: This novel ethics education program was highly feasible and acceptable to hospital-based nurses who reported increased knowledge and confidence in providing ethical care. Simulated case-based ethics competencies were an appropriate evaluation method. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Journal of Aesthetic Education 38.2 (2004) 120-124 [Access article in PDF] Pictures & Tears. a History of People Who Have Cried in Front of Paintings, by James Elkins. London: Routledge, 2001, xiii + 272pp., $26. In "Tears, Idle Tears" from The Princess, Alfred, Lord Tennyson wonders at the tears forming in his eyes as he gazes out across the fields one fall day. The idyllic countryside, far (...) from providing solace, triggers within him a debilitating sadness, an all-encompassing melancholia, manifested by the tears originating from a deep despair; the autumn fields remind Tennyson's narrative persona of all the days that have passed by him.If Tennyson's eyes had fallen not on autumn fields but on a painting of them then the opening lines to "Tears, Idle Tears" might have served as the perfect epigraphic frame to James Elkins's important study of the tears we do and do not shed when looking at art.One of several recent books by the increasingly influential professor at Chicago's School of the Art Institute, Pictures & Tears probes that aspect of our consciousness that has the capacity [End Page 120] to move us to tears when looking at paintings.Shedding tears in front of paintings? Within contemporary culture it seems rather unlikely for someone to respond to a painting by fighting off, or giving in, to tears. Reactions to paintings in previous periods and societies were wholly different from ours, Elkins argues. Paintings not only incited the passions but were blamed for the onset of numerous, serious medical conditions. Though rare today, cases continue to be reported. The Italian psychiatrist Graziella Magherini even coined a term for it in 1989, "Stendhal syndrome," referring to the novelist whose viewing of art in Florence was accompanied by the onset of a form of nervous exhaustion.While the subtitle of Elkins's book suggests a history of crying in front of pictures, leading us to the nearly tearless present, and thus, presumably, to answers about why we no longer cry in front of paintings, A History of People Who Have Cried in Front of Paintings is somewhat misleading. In the truest sense Pictures & Tears is neither a history of crying in front of pictures nor individual histories of those who have. The book does not follow a linear historical narrative of the tears that pictures have evoked over the centuries. Rather, Elkins's chapters constitute a tableau, the accumulation of fragments, with alternating chapters exploring, first, a particular work of art and the tears it has evoked and, second, ruminations on why that might be the case.At the heart of Elkins's argument is a concern over why we no longer seem willing, or indeed able, to have emotional responses to paintings. Besides the occasional grand response to works of art, particularly those vested withsignificant religious meaning, few admit to intimate connections with paintings. Elkins wants to know why.To answer these questions, Elkins turned to colleagues as well as to people he had never met. His research for the book included letters to fellow scholars and peers, and open calls in newspapers and journals, requesting stories from anyone moved to tears on encountering a painting. He received more than four hundred responses, many of which are included in a substantial appendix. The responses themselves make for an intriguing read and from them Elkins builds a two-pronged argument: we now live in an age that is marked by "stoic intellectualism" (p. 163), yet we still have the capacity to feel an intimate connection to paintings. Art in recent years has demanded greater intellectual engagement, lessintimate involvement. There may be exhibitions that fuel fear, distrust, anger, or rage but these are alienating to the works themselves, although these feelings can certainly be as intense as the more intimate connection that Elkins equates with falling in love.What is it about viewing paintings, as opposed to film or theater, he asks, which prevents full emotional expression? Is it the accoutrements used to view gallery paintings — the exhibition catalogs... (shrink)

This article is an attempt to expound and distinguish\nbrentano's concept of "Intentional inexistence" (found in\n'psychologie von einem empirischen standpunkt') and\nhusserl's early concept of intentionality (in 'logische\nuntersuchungen'). The main purpose is to show that\nhusserl's phenomenological views are very different from\nand far more developed than brentano's and that he rejects\nmany of his concepts and doctrines. First, brentano's\ndesignation of eight defining characteristics of mental\nphenomena, the purpose of which is to define psychology, is\noutlined. This is followed by a detailed discussion of\nhusserl's criticisms and revisions, (...) emphasizing what\nhusserl thought was brentano's most important insight,\ni.E., That consciousness is intentional. A discussion of\nthree views of the nature of consciousness is given,\nconcluding with husserl's general criticisms that brentano\nfell victim to dualism and representationalism and that his\nconcept of the intentional nature of mind was distorted by\na commitment to naturalism, the latter being overcome only\nby husserl's own transcendental phenomenology in 'ideen'\nand later works. (shrink)

Thucydides uses the first extended episode in the History, the Corcyrean conflict , to present the world of political discourse, deliberation, and battle. This episode is programmatic for a number of reasons: it is the first episode with a pair of speeches; Thucydides ties this episode directly to the outbreak of the war; certain questions, such as morality's relevance to foreign policy, are introduced here for the first time; and, most importantly, it is here that Thucydides establishes what the reader's (...) role is to be throughout the work. This paper argues that, for all the significance of Thucydides' Archaeology and Statement of Method , the "participatory" dimension of the History begins with the Corcyrean conflict. It is only with the introduction of speeches that the reader must address the ways in which speech and narrative confirm and undermine each other, as the historian's voice now alternates and competes with that of his characters in speech. From an authorial perspective we find that various techniques Thucydides employs-multiple perspective, authorial reticence, and episodic presentation-are used to recreate the political arena of fifth-century Greece. The various facets of the reader's extensive labor may be clustered under the heading of extrapolation and conjecture , as the reader must endeavor to see events from the perspective of the participants, evaluate claims made in speeches, experience battle vicariously, and consider events-which are past from the reader's perspective-as future in terms of the subsequent narrative. Analogous to what Plato did for philosophy, Thucydides has produced an interactive, open-ended, and participatory type of literature by appealing to the reader's involvement and by bringing written literature as close as possible to the live, extemporaneous, face-to-face debate of oral Greek culture. (shrink)

Verbal autopsy presents the opportunity to understand the disease burden in many low-income countries where vital registration systems are underdeveloped and most deaths occur in the community. Advances in technology have led to the development of software that can provide probable cause of death information in real time, and research considering the ethical implications of these advances is necessary to inform policy. Our research explores these ethical issues in rural Nepal using a public health ethics framework. We considered the burdens (...) and benefits of VA and giving cause of death information to families of the deceased through qualitative research with VA interviewers, community members, national policy stakeholders and international academics. Burdens can be experienced differently, and it is important to balance the emotional burden of VA with utilization of the data to inform planning and increased access to health services. The training, support and supervision of VA interviewers should be prioritized if VA is taken to scale. Initial and ongoing community engagement is recommended in addition to engaging ethical, legal, health and policy personnel in developing protocols and systems. Integrating rigorous research while cautiously moving forward is recommended to ensure systems and responses to concerns are relevant to contexts. (shrink)

Critic, poet and philosopher Friedrich von Schlegel (1772–1829) was a leading figure of German Romanticism. In the two years before his untimely death, he wrote three cycles of lectures intended as part of a larger project to lay the foundations of a new general philosophy. Two of these cycles, 'Philosophie des Lebens' (given in 1827, published 1828) and 'Philosophie des Sprache und des Wortes' (given in December 1828 and published posthumously), are reissued here in an 1847 English translation. The first (...) presents Schlegel's understanding of philosophy as independent of theology or politics, concerned with the 'inner spiritual life' of humankind. The second explores the nature of communication through language and art. Schlegel argues that full human consciousness cannot be restored by Enlightenment science, but only by divine revelation and redemption. He offers no ready-made solutions, but encourages his listeners to develop their own responses to these questions. (shrink)