It is possible to find in Machiavelli an expression of the original consent to explain the origin of the political communities. This paper investigates this hypothesis in the approach of the roman political thought. With Lucretius and Cicero, it is clear the terms of the pact, covenant, consensus, and the primitivism of the difference between man and beasts, the fear and the common safety to founder the political community under the leadership of one man. The paper also debates the Aristotelian (...) premises of the political nature of man and explores some examples of the Machiavellian time, that aims to confirms the existence of the language of the Aristotelianism within the original consent. It concludes that Machiavelli does not have a substantial theory to explain the origins of the political community, because politics and its study requires the research of the cities in the historical mean. This contractual language in accordance with that Aristotelian is used as a rhetoric strategy in the beginning of the Discourses. (shrink)

Neste artigo, analisamos, a partir de grupos focais realizados em Rio de Janeiro, Brasília, Salvador e Manaus, as transformações nas dinâmicas de trabalho de profissionais de comunicação em cenários de desinformação pós-covid-19. Observamos como o local configura modos específicos de lidar com a desinformação e realizar o trabalho de comunicação. Concluímos que, além das experiências sociais diversas, há uma demanda comum pela necessidade de formação específica em comunicação e saúde, bem como pela reversão dos processos acelerados de precarização do trabalho.

The rapidly increasing number of cases of Zika virus and limited understanding of its congenital sequelae (e.g., microcephaly) led to stories of fear and uncertainty across social media and other mass communication networks. In this study, we used techniques generic to netnography, a form of ethnography, using Internet‐based computer‐mediated communications as a source of data to understand the experience and perceptions of families with infants diagnosed with Zika‐related microcephaly. We screened 27 YouTube™ videos published online between October 2015 and July (...) 2016, during which the Zika epidemic started, peaked, and declined. We identified three themes: (a) experiencing the news of a diagnosis of Zika‐associated microcephaly; (b) experiencing feelings and expectations of the ‘imperfect’ child; and (c) seeking to understand microcephaly to care for the child. We found that families experienced distressing feelings of shock, sadness, hopelessness, and pain, while dealing with emerging and sometimes conflicting information being transmitted by news outlets, uncertainty about the child's health, and healthcare providers’ lack of clarity to guide the family members. The ‘unknown’ factor of ZIKA was an additional stressful factor in the experience of the families. (shrink)

ABSTRACT In this article, I propose a dialogical analysis of five online cartoons which reverberate the discourse of the former president of Brazil (2019-2022) at the UN in September 2020, when he called the international community to combat Christphobia. Named after the same term, the cartoons present a framework of interdiscursive antagonism between Christian and the former President of Brazil’s fanatic followers’ positions. Assuming that cartoons are a privileged discursive genre for understanding the dialogical resonances between interlocutors and discourses, this (...) work approaches Christphobia as a responsive utterance in terms of scales of meaning. From the analysis, one can see a discursive game of incompatibility and estrangement, that makes room to a Christophobic “Other” in opposition to a persecuted “minority us,” as once presented during the UN discourse. There is an emphasis on a perception of religious intolerance as a result of the political agenda of the former president of Brazil’s religious-ideological alignment. (shrink)

Remarks on the Structure of the Recherche de la Verité: The Role of Vision in God: The present article will discuss the argumentative context in which Nicolas Malebranche presents the doctrine of the vision in God in his work, Recherche de la Verité. Malebranche is known for this doctrine about human cognition, and also for his occasionalistic view of causality, and such positions are only properly understood when put in the argumentative context designed by the author, which is not usually (...) seen in commentaries. With this goal, we intend to look into the precise position of the vision of God in the Recherche and to identify the argument of the work as a whole. Thus, by seeing how the malebranchean theory of cognition fits in his philosophical project, we will be able to adequately reconstruct this important and influential philosophical doctrine of the seventeenth century.Keywords: Nicolas Malebranche. Recherche de la Verité. Vision in God. Considerações sobre a Estrutura da Recherche de la Verité: O Papel da Visão em Deus Resumo: No seguinte artigo abordamos o contexto argumentativo em que se insere a doutrina da visão em Deus de Nicolas Malebranche na sua obra, Recherche de la Verité. Ainda que Malebranche seja conhecido tanto por essa doutrina acerca da cognição humana, quanto pela sua visão ocasionalista da estrutura causal, tais posições só são adequadamente compreendidas quando as colocamos no contexto argumentativo projetado pelo autor, o que costumeiramente não é feito. Com isso, pretendemos situar a posição da visão em Deus na Recherche partindo, em um primeiro momento, da análise do fio condutor da obra. Desse modo, ao vislumbrarmos de que modo uma teoria da cognição se encaixa no projeto filosófico malebranchista, seremos capazes de reconstruir adequadamente essa importante e influente doutrina filosófica do século XVII.Palavras-chave: Nicolas Malebranche. Recherche de la Verité. Visão em Deus. Remarques sur la Structure de la Recherche de la Verité: Le Rôle de la Vision em Dieu Résumé: Dans l’article suivant, nous abordons le context argumentative dans lequel la doctrine de la vision en Dieu de Nicolas Malebranche est insérée dans la Recherche de la Verité. Bien que Malebranche soit connu à la fois pour cette doctrine de la cognition humaine et pour sa perspective ocasionelle de la structure causale, de tells positions ne sont correctement comprises que lorsque nous les plaçons dans le context argumentative conçu par l’auteur; ce qui n’est généralement pas fait. Avec cela, nous avons l’intention de situer la position de la vision en Dieu dans la Recherche comme fil conducteur de l’oeuvre. De cette façon, lorsque nous entrevoirons comment une théorie de la cognition s’intègre dans le projet philosophique malebranchiste, nous serons en conditions de reconstruire correctement cette important et influent doctrine philosophique du XVIIe siècle.Mots-clés: Malebranche. Recherche de la Verité. Vision em Dieu. Data de registro: 04/05/2020Data de aceite: 26/08/2020. (shrink)

Este trabajo tiene como objetivo discutir la modernidad y el otro en la obra Islands of Decolonial Love, de Leanne Simpson. El autor presenta una voz indígena persuasiva que ha atraído la atención de muchos lectores más allá de las fronteras del Canadá sobre cuestiones relacionadas con la tierra y los indígenas, el extractivismo y el medio ambiente. En la obra enfocada, el autor acerca al lector no indígena a la construcción del conocimiento indígena presentando un material que va más (...) allá de la palabra escrita. La nación a la que pertenece Simpson y tantos otros pueblos indígenas han sufrido las marcas de la colonización. Pensar en las narraciones y conversaciones de los personajes de Islands of Decolonial Love es hacer que el lector reflexione sobre las ‘grietas’ invisibles que el proceso de civilización y su lado ‘oscuro’ desatan bajo la ‘ética’ de la retórica de la modernidad y el discurso progresista del capitalismo. No se puede negar la existencia del otro. (shrink)

“O Niilismo” foi publicado pela primeira vez em 1996, em Roma, e posteriormente traduzido para várias línguas. Nesta obra, Volpi quis apresentar, ao longo dos quinze capítulos, um itinerário da história do conceito e do problema do niilismo.

Franco Volpi foi um filósofo italiano e professor de História da Filosofia da Universidade de Pádua. Também lecionou em universidades da Europa, Canadá e América Latina. Publicou obras como “Heidegger e Brentano”, “O Renascimento da Filosofia Prática na Alemanha”, “Heidegger e Aristóteles”, “Dicionário de Trabalhos Filosóficos”, entre outros.

O presente artigo pretende discutir o processo de formação de identidades sociais online nos ‘mundos virtuais’ - nossa hipótese é a de que a presença do que Salen e Zimmerman (2003) chamam de ‘círculo mágico’ exerça uma força mediadora que singulariza o processo de criação de identidades sociais, de modo a tornar tal particularização algo digno de atenção pelos estudos da cibercultura.

Since the later decades of the 20 th century, Brazilian psychologists have been questioning a theoretical and interventional model in educational contexts, which consider psychological phenomena apart from their cultural contexts, in order to develop an approach based on a contextualized viewpoint. Despite progress having been made in educational psychology, as a result of this critical paradigm, this area still has problems to overcome: Psychologists are becoming increasingly separate from schools, and it is now common to find psychologists who are (...) professionally unprepared to perform in this context and furthermore, school principals do not always understand the role of psychologists in educational settings. However, educational demands exist in psychologists’ daily work in a range of contexts, indicating the relevance of this field and the urgency to improve psychologists' qualifications. Considering that Brazilian professional development programs for educators and psychologists are usually restricted to technical learning, often ignoring professionals’ real needs and claims, this research aimed to develop a special type of professional development program looking at the group as a source of development, in order to rethink professional development process from within a collaborative perspective. Research data was generated from a professional development program offered for psychologists and professionals who work within educational settings. This programme involved collaborative group work and was organized and conducted in such a way as to create conditions for change. Concepts of cultural-historical theory – social situation of development, crisis and perezhivanie – were used as analytic tools for data analysis. Analysis indicated the importance of the group as a source of development through dialogue and the co-construction of new ideas and possibilities. (shrink)

O livro Retórica da Evidência : ou Descartes segundo a ordem das imagens, de Leonel Ribeiro dos Santos, apresenta uma diferente abordagem da filosofia cartesiana. Propõe uma interpretação onde o suposto rompimento do cartesianismo com as fontes medievais e renascentistas precisa ser atenuado.

While previous research has suggested that adults with a history of childhood sexual abuse may be more prone to produce false memories, little is known about the consequences of childhood neglect on basic memory processes. For this reason, the authors investigated how a group of women with a history of childhood emotional neglect and diagnosed with recurrent Major Depressive Disorder performed on the Deese–Roediger–McDermott paradigm in comparison to control groups. The results indicated that women with MDD and CEN were actually (...) less prone to produce false memories relative to both women with MDD but no CEN and healthy women without MDD and any form of childhood maltreatment. These findings were explained in terms of the inability to extract/retrieve gist memories that support false recognition of critical lures, an explanation that seems to fit well with emerging MRI findings linking childhood neglect to reduced volume of brain regions associated to memory function. (shrink)

O trabalho analisa, por meio da cobertura do diário A Tarde, de Salvador, a convivência entre a delegação alemã de futebol e a população local de Santa Cruz Cabrália, no sul da Bahia, que serviu de base para a seleção que conquistou a Copa do Mundo de futebol em 2014. A partir dos critérios de identidade cultural, globalização e seleção jornalística, mostra que a estratégia de aproximação com os moradores marcou a cobertura de A Tarde e criou um clima simpático (...) à seleção alemã. (shrink)

Este artigo estuda alguns aspectos de uma das maiores transformações na história do pensamento estético, nomeadamente, a teorização estética do feio. A seguir a referências a concepções estéticas do feio em E. Lessing e F. Schlegel, é estudada a concepção dialética do feio segundo o Sistema da Estética (1830) de Ch. H. Weisse, da escola hegeliana. O feio é entendido então como a aparição não sublimada da contradição inerente ao finito. Esta concepção abre caminho à Estética do Feio, de K. (...) Rosenkranz, a única e certamente primeira estética do feio, completa, independente e sistemática. Através do estudo das suas teses principais e de alguns exemplos citados pelo autor, mostra-se como a estética do feio de Rosenkranz, apesar da sua pertença ainda em parte a cânones clássicos, abre o caminho para a autonomização do feio e à substituição de uma estética da beleza por outros valores, participando de um movimento de transformação da razão mais geral iniciado no final do séc. XVIII. (shrink)

Nesta entrevista, Klaus Vieweg responde a algumas questões acerca da sua nova biografia de Hegel, intitulada Hegel: O Filósofo da Liberdade, bem como das suas propostas interpretativas e de renovação do pensamento de Hegel. Trata‑se na entrevista, nomeadamente, da crítica, que se espera definitiva, à interpretação errada de Hegel como um defensor de uma acomodação ou mesmo de uma política da restauração pelo estado prussiano; da relação de Hegel com a tradição filosófica, em especial com o paradigma da consciência e (...) com o estado moderno; das teses de Hegel acerca da ética ambiental; e do debate entre interpretações metafísicas e não‑metafísicas de Hegel. (shrink)

Neste breve texto é apresentado o Dossier temático dedicado à recente publicação, por Klaus Vieweg, de uma nova biografia de Hegel. Trata‑se de um importate acontecimento editorial e para o assinalar, este Dossier reúne uma entrevista com o autor e uma tradução de algumas páginas onde Klaus Vieweg nos oferece um contexto introdutório da vida de Hegel.

Assumindo que a arquitetura e o pensamento filosófico a seu respeito são elementoes essenciais para a auto-compreensão do humano, este artigo defende três pontos acerca do papel do espaço e do tempo na arquitetura funcionalista e na sua crítica. Dois exemplos significativos na História da Filosofia, nomeadamente, o conceito platónico de espaço e o conceito kantiano de esquema mostram que o espaço e o tempo como elementos básicos da experiência humana estão intimamente relacionados com a sensibilidade e a imaginação e (...) não podem ser reconduzidos a uma funcionalização exclusivamente objetiva. Defendo, em segundo lugar, que o funcionalismo arquitetónico não tomou deliberadamente em consideração os aspectos do espaço e do tempo que os ligam à sensibilidade e à imaginação. Como resultado dos pontos precedentes, complementados por referências à posição do funcionalismo em relação ao tempo histórico e à relação de meios e fins, e considerando alguns autores importantes do séc. XX, um terceiro ponto é defendido, a saber que as insuficiências atribuídas ao funcionalismo derivam do facto de que este ignorou o espaço e o tempo na sua relação com a sensibilidade e a imaginação. Estas teses mostrarão, finalmente, que a arquitetura pode ser entendida como um esquema sensível da auto-compreensão humana. (shrink)

O conhecimento tem sido objeto de reflexão e estudo em várias áreas do saber, bem como elemento-chave nas grandes transformações enfrentadas pela humanidade. Assim, a autorreflexão, conforme aponta Jürgen Habermas refere-se a um processo de análise crítica e autorreflexiva realizado por indivíduos e pela sociedade como um todo. A autorreflexão também está associada ao desenvolvimento do entendimento crítico, o que permite que os sujeitos, de modo coletivo avaliem constantemente suas próprias ações e instituições em relação aos padrões de justiça, igualdade (...) e compensação. Em termos mais amplos, a autorreflexão em Habermas está relacionada ao conceito de “espaço público” e à ideia de que uma sociedade saudável e democrática requer um diálogo público aberto e crítico, o que fundamenta a pesquisa-ação. Encontramos na pesquisa-ação uma abordagem que combina a investigação acadêmica com a ação prática para promover mudanças sociais, envolvendo a colaboração entre pesquisadores e membros da comunidade, visando gerar conhecimento relevante e aplicável às questões enfrentadas por estas. Perante o exposto, toma-se como objetivo principal tecer considerações acerca do conceito de autorreflexão para estratégia de produção de dados numa pesquisa-ação crítica. Trata-se de um relato de pesquisa que visa refletir acerca da autorreflexão incorporada na metodologia da pesquisa-ação, principalmente no tocante à formação continuada de profissionais da educação. Nesse contexto, acredita-se que, a partir da autorreflexão crítica tais profissionais possam constituir-se em uma comunidade autocrítica de pesquisadores que investigam suas concepções e ações, possibilitando outros/novos modos de conceber e produzir conhecimentos. (shrink)

Em busca de superar uma racionalidade reducionista instaurada por décadas na produção de conhecimentos na área da educação, propomos neste artigo, considerando a teoria do Agir Comunicativo, realizar uma discussão sobre os Espaços Discursivos. Estes vêm se configurando em uma proposta para produção de dados, de modo a considerar a intersubjetividade dos sujeitos e a autorreflexão como meios constituintes de saberes. Seus princípios estão alicerçados na ética do discurso desenvolvido por Habermas. A construção da metodologia em tela, tem-se dado pela (...) via dos estudos desenvolvidos pela pesquisa-ação, que a partir de pesquisas desenvolvidas tece algumas considerações teórico-metodológicas e epistemológicas apresentadas nesse momento. Considerando este mesmo movimento, percebe-se que a produção de dados pela via dos Espaços Discursivos permite um diálogo ético e democrático com os envolvidos, na busca de consensos acerca das temáticas propostas, sendo a argumentação, neste contexto, a base para estruturação do conhecimento na área educativa. (shrink)

Background: The COVID-19 crisis has had a considerable mental health impact on healthcare workers. High levels of psychological distress are expected to have a significant impact on healthcare systems, warranting the need for evidence-based psychological interventions targeting stress and fostering resilience in this population. Online cognitive behavioral therapy has proved to be effective in targeting stress and promoting resilience. However, online CBT programs targeting stress in healthcare workers are lacking.Objective: The aim of our study is to evaluate the feasibility and (...) acceptability of an internet-based CBT intervention, the My Health Too program we developed during the first COVID-19 epidemic peak in France.Methods: We recruited 10 participants among Alsace region hospital staff during the first peak of the pandemic in France. They were given 1 week to test the website and were then asked to answer an internet survey and a semi-structured phone interview.Results: We conducted a thematic analysis of the content from the phone interviews. Major themes were identified, discussed and coded: the technical aspects, the content of the website and its impact on participants’ emotions and everyday life. Overall, the participants reported finding the website easy to use and interactive. They described the resources as easy to understand, readily usable, and useful in inducing calm and in helping them practice self-compassion.Conclusion: Our results suggest that the My Health Too online CBT program is highly feasible and acceptable to healthcare workers during the highly stressful times of the pandemic peak. The feedback provided helped to improve the program whose efficacy is to be tested. (shrink)

Toma-se como objetivo tecer considerações acerca do conceito de autorreflexão e emancipação, entrelaçando-o à pesquisa-ação, por meio do diálogo entre Jürgen Habermas, Theodor W. Adorno, Wilfred Carr e Stephen Kemmis. Os conceitos de autorreflexão e emancipação surgem na Escola de Frankfurt através de Adorno e são incorporados por Habermas, que dá outro sentido a eles. Carr e Kemmis, ao refletirem sobre a pesquisa-ação emancipatória na educação, tomam Habermas como alicerce e constituem o conceito de autorreflexão crítica. A partir das considerações (...) dos autores, o artigo reflete acerca da autorreflexão incorporada na metodologia da pesquisa-ação, principalmente no tocante à formação continuada de profissionais da educação. À luz dos pressupostos habermasianos, defendem-se os conceitos de autorreflexão e emancipação pela via da ação comunicativa, na qual o paradigma da consciência é transposto para o paradigma da linguagem. Compreende-se que para Adorno a autorreflexão está atrelada diretamente à liberdade, ao pensamento crítico e à autonomia, que guiam o indivíduo para a emancipação. Enquanto para Habermas, a autorreflexão vincula-se à linguagem e à comunicação, entre dois ou mais sujeitos, que os guiam para a emancipação. Carr e Kemmis inspirados na espiral cíclica proposta por Lewin e na autorreflexão de Habermas, vão defender a espiral autorreflexiva na pesquisa-ação. Diante disso, entende-se que os problemas da educação têm na racionalidade comunicativa perspectivas de mudanças sólidas, especialmente pela via de processos formativos. (shrink)

BackgroundMoral distress (MD) is the psychological damage caused when people are forced to witness or carry out actions which go against their fundamental moral values. The main objective was to evaluate the prevalence and predictive factors associated with MD among health professionals during the pandemic and to determine its causes.MethodsA regional, observational and cross-sectional study in a sample of 566 professionals from the Public Health Service of Andalusia (68.7% female; 66.9% physicians) who completed the MMD-HP-SPA scale to determine the level (...) of MD (0-432 points). Five dimensions were used: i) Health care; ii) Therapeutic obstinacy-futility, iii) Interpersonal relations of the Healthcare Team, iv) External pressure; v) Covering up of medical malpractice.ResultsThe mean level of MD was 127.3 (SD=66.7; 95% CI 121.8-132.8), being higher in female (135 vs. 110.3; p<0.01), in nursing professionals (137.8 vs. 122; p<0.01) and in the community setting (136.2 vs. 118.3; p<0.001), with these variables showing statistical significance in the multiple linear regression model (p<0.001; r2=0.052). With similar results, the multiple logistic regression model showed being female was a higher risk factor (OR=2.27; 95% CI 1.5-3.4; p<0.001). 70% of the sources of MD belonged to the dimension "Health Care" and the cause "Having to attend to more patients than I can safely attend to" obtained the highest average value (Mean=9.8; SD=4.9).ConclusionsFemale, nursing professionals, and those from the community setting presented a higher risk of MD. The healthcare model needs to implement an ethical approach to public health issues to alleviate MD among its professionals. (shrink)

BackgroundMoral distress has been described as an emotionally draining condition caused by being prevented from providing care according to one’s convictions. Studies have described the impact of moral distress on healthcare professionals, their situations and experiences. The Measure of Moral Distress for Healthcare Professionals (MMD-HP) is a questionnaire that measures moral distress experienced by healthcare professionals at three levels: patient, system and team. The aim of this project was to translate and make a cultural adaption of the MMD -HP to (...) the Swedish context.MethodsThe questionnaire comprises 27 items, rated according to frequency and intensity on a five-point Likert scale (0–4). The procedure for translating MMD-HP followed WHO guidelines (2020). These entailed a forward translation from English to Swedish, a back translation, expert panel validation, pretesting and cognitive face-to-face interviews with 10 healthcare professionals from various professions and healthcare contexts.ResultsThe Swedish version of MMD-HP corresponds essentially to the concept of the original version. Parts of some items’ had to be adjusted or removed in order to make the item relevant and comprehensible in a Swedish context. Overall, the cognitive interviewees recognized the content of the items which generally seemed relevant and comprehensible.ConclusionThe Swedish version of MMD-HP could be a useful tool for measuring moral distress among healthcare professionals in a Swedish healthcare context. (shrink)

BackgroundThe COVID-19 pandemic has created ethical challenges for intensive care unit (ICU) professionals, potentially causing moral distress. This study explored the levels and causes of moral distress and the ethical climate in Dutch ICUs during COVID-19.MethodsAn extended version of the Measurement of Moral Distress for Healthcare Professionals (MMD-HP) and Ethical Decision Making Climate Questionnaire (EDMCQ) were online distributed among all 84 ICUs. Moral distress scores in nurses and intensivists were compared with the historical control group one year before COVID-19. ResultsThree (...) hundred forty-five nurses (70.7%), 40 intensivists (8.2%), and 103 supporting staff (21.1%) completed the survey. Moral distress levels were higher for nurses than supporting staff. Moral distress levels in intensivists did not differ significantly from those of nurses and supporting staff. “Inadequate emotional support for patients and their families” was the highest-ranked cause of moral distress for all groups of professionals. Of all factors, all professions rated the ethical climate most positively regarding the culture of mutual respect, ethical awareness and support. “Culture of not avoiding end-of-life-decisions” and “Self-reflective and empowering leadership” received the lowest mean scores. Moral distress scores during COVID-19 were significantly lower for ICU nurses (p < 0.001) and intensivists (p < 0.05) compared to one year prior.ConclusionLevels and causes of moral distress vary between ICU professionals and differ from the historical control group. Targeted interventions that address moral distress during a crisis are desirable to improve the mental health and retention of ICU professionals and the quality of patient care. (shrink)

Aims The study aims to test the Turkish validity and reliability of the Rushton Moral Resilience Scale (RMRS) and examine the effect of moral resilience on moral distress. Background Moral distress is a phenomenon that negatively affects health workers, health institutions, and the person receiving care. In order to eliminate or minimize the negative effects of moral distress, it is necessary to increase the moral resilience of nurses. Moral resilience involves developing systems that support a culture of ethical practice in (...) healthcare and aim to increase an individual’s capacity to cope with moral challenges. Methods A methodological and descriptive-predictive study design was adopted. Sociodemographic Information Form, Measure of Moral Distress – Healthcare Professionals (MMD-HP), and Rushton Moral Resilience Scale were used to collect data from the nurses. A total of 255 clinical nurses were recruited. Ethical considerations Hacettepe University’s non-interventional ethics committee approved the study’s protocol and informed consent was obtained from the participants. Results The original four-factor structure of the scale was tested with confirmatory factor analysis, and the index values were evaluated and found at an acceptable level. The Cronbach Alpha coefficient of the scale was found to be 0.826. Moral resilience predicted moral distress total, intensity, and frequency levels. A moderate and weak relationship was found in the negative between all sub-dimensions of moral distress and moral resilience. Conclusions The Rushton Moral Resilience Scale Turkish version showed good psychometric properties. Moral resilience has a reducing effect on moral distress. Young nurses who have less experience are at risk because they have lower moral resilience levels, while nurses working in intensive care units are at risk because of their high moral distress levels. A healthy workplace can be created by developing specific approaches to improve moral resilience in reducing the impact of moral distress in the healthcare environment. (shrink)

Background: Moral distress is recognized as a problem affecting healthcare professionals globally. Unaddressed moral distress may lead to withdrawal from the moral dimensions of patient care, burnout, or leaving the profession. Despite the importance, studies related to moral distress are scant in Thailand. Objective: This study aims to describe the experience of moral distress and related factors among Thai nurses. Design: A convergent parallel mixed-methods design was used. The quantitative and qualitative data were collected in parallel using the Measure of (...) Moral Distress for Healthcare Professionals and interview guide. The analysis was conducted separately and then integrated. Participants: Participants were Thai nurses from two large tertiary care institutions in a Southern province of Thailand. Ethical considerations: This study was approved by our organization's Institutional Review Board for Health Sciences Research, and by the Institutional Review Boards of the two local institutions in Thailand. Permission from the publisher was received to translate and utilize the Measure of Moral Distress (MMD-HP) under the license number: 4676990097151. Results: A total of 462 participants completed the survey questions. The top 7 causes of moral distress were related to system-level root causes and end-of-life care situations. Hierarchical multiple regression showed that work units, considering leaving position, and number of moral distress episodes in the past year were significant predictors of moral distress. Twenty interviews demonstrated three main themes of distressing causes: (1) powerlessness (at patients/family-, team-, and organizational-levels), (2) end-of-life issues, and (3) poor team function (poor communication and collaboration, incompetent healthcare providers, and inappropriate behavior of colleagues). The integration of data from both components indicated that the qualitative interviews enrich the quantitative findings, especially as related to the top 7 causes of moral distress. Discussion: Although the experience of moral distress among Thai nurses is similar to studies conducted elsewhere, the patient’s and family’s religious perspective that ties into the concept of moral distress needs to be explored. Conclusions: Although the root causes of moral distress are similar among different cultures, the experience of Thai nurses may vary according to culture and context. (shrink)

Background Although, moral distress presents a serious problem among critical care nurses in many countries, limited research has been conducted on it. A validated scale has been developed to evaluate moral distress and has enabled cross-cultural comparison for seeking its root causes. Research aims This study aimed to (1) clarify the current status of moral distress among nurses who worked in critical care areas in Japan, (2) compare the moral distress levels among nurses in Japan with previously reported results from (...) the United States (US), and (3) explore the factors associated with moral distress. Research design A nationwide cross-sectional study was conducted. Participants and research context We conducted a self-administered questionnaire survey using the Measure of Moral Distress–Healthcare Professionals (MMD-HP) among critical care nurses who were randomly selected from hospitals across Japan. The mean differences between the two countries were compared using a Student's t-test with summary statistics. The factors associated with higher levels of moral distress were examined using a multiple regression analysis. Ethical considerations The study was approved by the Ethics Committee of the Tokyo Medical and Dental University (approval nos. M2018-214 and M2019-045). Results We obtained 955 valid responses from 94 facilities. In Japan, the items with the highest moral distress scores were those related to aggressive/inappropriate treatment. The total MMD-HP score was significantly higher in Japanese nurses compared to US nurses (122.8 ± 70.8 vs 112.3 ± 73.2). Some factors, such as leadership experience, were associated with higher moral distress. Discussion The top root causes of moral distress were similar to potentially inappropriate treatments in both countries. Conclusion This study revealed the factors associated with higher moral distress and its characteristics in each country. These results can be used for reducing moral distress in the future. (shrink)

Background Moral distress is a problem and negative experience among health-care professionals. Various instruments have been developed to measure the level and underlying reasons for experienced moral distress. The moral distress thermometer (MDT) is a single-tool instrument to capture the level of moral distress experienced in real-time. Aim The aim of this study was to translate the MDT and adapt it to the Swedish cultural context. Research design The first part of this study concerns the translation of MDT to the (...) Swedish context, and the second part the psychometric testing of the Swedish version. Participants and research context 89 healthcare professionals working at a hospital in northern Sweden participated. Convergent validity was tested between MDT and Measure of Moral Distress-Healthcare Professionals (MMD-HP), and construct validity was tested by comparing MDT scores among healthcare professionals. MDT was compared with responses to the final questions in MMD-HP. One-way ANOVA, Welch’s ANOVA, Games–Howell post-hoc test and Pearson’s correlation analysis were done. Ethical considerations The study was approved by the Swedish Ethics Review Authority (dnr 2020-04120) in accordance with Helsinki Declaration. Results The translated Swedish version of MDT was described as relevant to capture the experience of moral distress. The mean value for MDT was 2.26, with a median of 2 and a mode value of 0. The result showed moderate correlations between the MDT and MMD-HP total scores. There was a significant difference when comparing MDT and healthcare professionals who had never considered leaving their present position with those who had left and those who had considered leaving but had not done so, with the latter assessing significantly higher moral distress. Conclusion The MDT is an easily available instrument useful as an extension to MMD-HP to measure the real-time experience of moral distress among healthcare professionals in a Swedish context. (shrink)

Many pragmaticians have distinguished three levels of meaning involved in the comprehension of utterances, and there is an ongoing debate about how to characterize the intermediate level. Recanati has called it the level of 'what is said' and has opposed the idea that it can be determined semantically - a position that he labels 'pragmatic minimalism lo this end he has offered two chief arguments: semantic underdeterminacy and the Availability Principle. This paper exposes a tension between both arguments, relating this (...) discussion with Carruthers's cognitive view of language, according to which some thoughts are, literally, sentences of our natural language. First we explain how this view entails minimalism, and we construct an argument based on semantic underdeterminacy that shows that natural language sentences do not have the compositional properties required to constitute thoughts. Then we analyze the example of a subject's overhearing a sentence without an interpretive context, arguing that in the light of the Availability Principle the corresponding thought can be regarded as a natural language sentence. Thus, semantic underdeterminacy and availability pull in different directions, and we claim that there is no characterization of the latter that can relieve this tension. We contend that Recanati's availability shares with Carruthers's introspectivism an overreliance on intuitions about what appears consciously in one's mmd. We conclude, therefore, that the Availability Principle ought to be abandoned. (shrink)

Conventional methods for fault diagnosis typically require a substantial amount of training data. However, for equipment with high reliability, it is arduous to form a large-scale well-annotated dataset due to the expense of data acquisition and costly annotation. Besides, the generated data have a large number of redundant features which degraded the performance of models. To overcome this, we proposed a feature transfer scenario that transfers knowledge from similar fields to enhance the accuracy of fault diagnosis with small sample. To (...) reduces the redundant information, data were filtered according to manifold consistency. Then, features were extracted based on CNN and feature transfer was conducted. For adequate fitness, the joint adaptation of conditional distribution and marginal distribution was used between the two domains. Minimum structural risk and MMD of adaptation were two indicators weighted for training the model. To test the efficiency of the model, we built an airborne fuel pump testbed, and contributed a new dataset that contained 15 categories of fault data, which serves as the small sample dataset in this research. Then the proposed model was applied in our experimental data. As a result, the fault diagnosis rate increases by 28.6% through our proposed model, which is more precise than other classical methods. The results of feature visualization further demonstrate that the features are more distinguished through the proposed method. All code and data are accessible on my GitHub. (shrink)

Background: Clinical research nurses experience unique challenges in the context of their role that can lead to conflict and moral distress. Although examined in many areas, moral distress has not been studied in clinical research nurses. Research aim: The aim of this study was to examine moral distress in clinical research nurses and the relationship between moral distress scores and demographic characteristics of clinical research nurses. Research design: This was a descriptive quantitative study to measure moral distress in clinical research (...) nurses using the Measure of Moral Distress – Healthcare Professionals (MMD-HP) administered electronically. Demographic data were also collected. Participants and research context: Registered nurses working in the clinical research nurse role ( N = 322) were recruited through use of social media, emails, digital flyers, and snowball recruitment. Data was analyzed using SPSS. Pearson’s correlation, independent t-test, and one-way ANOVA were performed to explore differences among the demographic variables. Ethical considerations: This study was approved by the Institutional Review Board at Texas Woman’s University. A consent statement was included, and completion of the questionnaire was construed as consent. Findings/results: Analysis revealed a mean overall moral distress score of 79.58 (SD = 64.27) and median of 67, with a range of 0–354. Moral distress scores were negatively correlated with clinical research nurse age ( r = 0-.156, p < 0.05). Reliability of the MMD-HP was demonstrated with a Cronbach’s alpha of 0.93. Conclusions: The findings demonstrate that clinical research nurses do experience moral distress and revealed a wide range of scores. Further research is necessary to determine potential patient impact due to moral distress and to develop processes to minimize moral distress in the clinical research setting. This study was conducted during the COVID-19 pandemic, and the digital recruitment methods proved effective in recruiting a wide range of clinical research nurses, both nationally and internationally. (shrink)

Background: The Measure of Moral Distress – Healthcare Professionals (MMD-HP) is a 27-item survey that quantifies moral distress. The MMD-HP was distributed to healthcare professionals (HPs), and analysis of a free-text response item revealed information-rich descriptions of morally distressing situations. Research question: What are HPs’ perceptions of their experiences of morally distressing situations? Research design: A descriptive, qualitative approach explored respondents’ free-text responses to the following open-ended response item: “If there are other situations in which you have felt moral distress, (...) please write and score them here.” Participants and research context: Eligible participants were HPs ( N = 8206) working in a large, multi-site healthcare system located in a major, urban city in the Southeastern United States. Ethical considerations: The Institutional Review Board provided approval for this research. A survey preamble supplied information, and consent was presumed with survey completion. Findings: Three themes were identified from 282 free-text responses: Theme 1: Compromised Quality of Care, Theme 2: Hostile Work Environment, and Theme 3: Ineffective Leadership. Conclusions: This study is unique because it provided in-depth qualitative analysis of morally distressing situations in a free-text response item across a wide array of HPs within multiple settings. Responses revealed that moral distress impacted the quality of patient care and provided descriptions of powerlessness to act. (shrink)

Background: Moral distress is the inability to do the right thing due to institutional constraints. The Measure of Moral Distress – Healthcare Professionals (MMD-HP) measures this phenomenon and has extensively explored moral distress among nurses. There are limited large-scale research studies using the MMD-HP to identify levels of moral distress across multiple healthcare professionals (HPs) and settings. Research question: What are the overall levels of moral distress among HPs? Research design: A quantitative, exploratory, cross-sectional study of HPs in a healthcare (...) system using the MMD-HP. Participants and research context: Eligible participants included HPs ( N = 8,206) working in all inpatient and outpatient units and centers in a multi-site healthcare system located in the Southeastern United States. Ethical considerations: The Institutional Review Board provided approval for this research. A survey preamble supplied information within the learning management system and consent was presumed with survey completion. Findings: A total of 3,561 HPs completed the MMD-HP. The top three morally distressing items included compromised patient care due to inadequate resources, caring for more patients than is safe, and low quality of patient care due to poor team communication. Intensive care unit (ICU) areas had significantly greater moral distress than all other areas ( p < 0.001). Formal leaders had the greatest moral distress ( p < 0.001). Mixed-acuity and medical-surgical HPs accounted for 22.8% of those who reported considering leaving their current position due to moral distress. Nurses represented 42.2% of those considering leaving their current position due to moral distress. Conclusions: This study uniquely identified that formal leaders and HP participants in the ICU setting had the greatest moral distress. Exploring moral distress is imperative for healthcare systems to decrease turnover, improve engagement, and the quality of patient care. (shrink)