Background Unit-based critical care nurse leaders (UBCCNL) play a role in exemplifying ethical leadership, addressing moral distress, and mitigating contributing factors to moral distress on their units. Despite several studies examining the experience of moral distress by bedside nurses, knowledge is limited regarding the UBCCNL’s experience. Research aim The aim of this study was to gain a deeper understanding of the lived experiences of Alabama UBCCNLs regarding how they experience, cope with, and address moral distress. Research design A qualitative descriptive (...) design and inductive thematic analysis guided the investigation. A screening and demographics questionnaire and a semi-structured interview protocol were the tools of data collection. Participant and research context Data were collected from 10 UBCCNLs from seven hospitals across the state of Alabama from February to July 2023. Ethical considerations This study was approved by the Institutional Review Board at the University of Alabama in Huntsville. Informed consent was obtained from participants prior to data collection. Findings UBCCNLs experience moral distress frequently due to a variety of systemic and organizational barriers. Feelings of powerlessness tended to precipitate moral distress among UBCCNLs. Despite moral distress resulting in increased advocacy and empathy, UBCCNLs may experience a variety of negative responses resulting from moral distress. UBCCNLs may utilize internal and external mechanisms to cope with and address moral distress. Conclusions The UBCCNL’s experience of moral distress is not dissimilar from bedside staff; albeit, moral distress does occur as a result of the responsibilities of leadership and the associated systemic barriers that UBCCNLs are privier to. When organizations allocate resources for addressing moral distress, they should be convenient to leaders and staff. The UBCCNL perspective should be considered in the development of future moral distress measurement tools and interventions. Future research exploring the relationship between empathy and moral distress among nurse leaders is needed. (shrink)

Moral distress (MD) is well-documented within the nursing literature and occurs when constraints prevent a correct course of action from being implemented. The measured frequency of MD has increased among nurses over recent years, especially since the COVID-19 Pandemic. MD is less understood among nurse leaders than other populations of nurses. A qualitative systematic review was conducted with the aim to synthesize the experiences of MD among nurse leaders. This review involved a search of three databases (Medline, CINAHL, and APA (...) PsychINFO) which resulted in the retrieval of 303 articles. PRISMA review criteria guided authors during the article review and selection process. Following the review, six articles were identified meeting review criteria and quality was assessed using the Critical Appraisal Skills Programme (CASP) Checklist for qualitative studies. No ethical review was required for this systematic review. The six studies included in this review originated from the United States, Brazil, Turkey, and Iran. Leadership roles ranged from unit-based leadership to executive leadership. Assigned quality scores based upon CASP criteria ranged from 6 to 9 (moderate to high quality). Three analytical themes emerged from the synthesis: (1) moral distress is consuming; (2) constrained by the system; and (3) adapt to overcome. The unique contributors of MD among nurse leaders include the leadership role itself and challenges navigating moral situations as they arise. The nurse leader perspective should be considered in the development of future MD interventions. (shrink)

A small large cardinal upper bound in V for proving when certain subsets of ω 1 (including the universally Baire subsets) are precisely those constructible from a real is given. In the core model we find an exact equivalence in terms of the length of the mouse order; we show that $\forall B \subseteq \omega_1 \lbrack B$ is universally Baire $\Leftrightarrow B \in L\lbrack r \rbrack$ for some real r] is preserved under set-sized forcing extensions if and only if there (...) are arbitrarily large "admissibly measurable" cardinals. (shrink)

Der siegreiche Zug der technische Zivilisation zerstörte die Harmonie des Menschen und der Umwelt, änderte traditionelle Wertvorstellungen. Der "technische Intellekt" ist nicht befähigt, Konkrete Probleme der menschlichen Geschichte zu lösen. Unter dem Vorwand des Kampfes mit diesem "technischem Intellekt" verstärken sich in der modernen Welt irrationalistlische Tendenzen, welche die Vernunft und die menschliche Rationalität im allgemeinen angreifen. In dieser Situation wächst die Rolle der sozialen Erkenntnis, di dialektisch-materialistische Rationalität verkörpert.

In this paper a formalized logic of propositions, PA1, is presented. It is proven consistent and its relationships to traditional logic, to PM ([15]), to subjunctive (including contrary-to-fact) implication and to the “paradoxes” of material and strict implication are developed. Apart from any intrinsic merit it possesses, its chief significance lies in demonstrating the feasibility of a general logic containing theprinciple of subjunctive contrariety, i.e., the principle that ‘Ifpwere true thenqwould be true’ and ‘Ifpwere true thenqwould be false’ are incompatible.

To controlforceaccurately under a wide range of behavioral conditions, the central nervous system would either require a detailed, continuously updated representation of the state of each muscle (and the load against which each is acting) or else force feedback with sufficient gain to cope with variations in the properties of the muscles and loads. The evidence for force feedback with adequate gain or for an appropriate central representation is not sufficient to conclude that force is the major controlled variable in (...) normal limb movements.Morton's hypothesis, thatlengthis controlled by a follow-up servo, has a number of difficulties related to the delays, gains, variability, and specificity in feedback pathways comprising potential servo loops. However, experimental evidence is consistent with these pathways providing servo assistance for some movements produced by coactivation of α- and static γ-motoneurons. Dynamic γ-motoneurons may provide an additional input for adaptive control of different types of movements.The idea that feedback is used to compensate for changes in musclestiffnesshas received experimental support under static postural conditions. However, reflexes tend to increase rather than decrease the range of variation in muscle stiffness during some cyclic movements. Theoretical problems associated with the regulation of stiffness are also discussed. The possibilities of separate control systems forvelocityorviscosityare considered, but the evidence is either negative or lacking. I conclude that different physical variables can be controlled depending on the type of limb movement required. The concept of stiffness regulation is also useful under some conditions, but should probably be extended to the regulation of the visco-elastic properties (i.e., the mechanical impedance) of a muscle or joint. (shrink)

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Changes being introduced to deregulate the Dutch health care system after decades of extensive state control are to be welcomed, and will in future require consumers to be ‘well‐informed, cost‐conscious and assertive patients, who are aware of their responsibility for their own health.’ R.B. Kool MD, PhD and E.J.J.M. Kimman PhD are attached to the Department of Business Ethics in the Faculty of Economics and Econometrics at The Free University, P.O. Box 7161, 10107 MC Amsterdam.

Prevalence of contract cheating and outsourcing through organised methods has received interest in research studies aiming to determine the most suitable strategies to reduce the problem. Few studies have presented an international approach or tested which variables could be correlated with contract cheating. As a result, strategies to reduce contract cheating may be founded on data from other countries, or demographics/situations which may not align to variables most strongly connected to engagement in outsourcing. This paper presents the results of a (...) series of statistical analyses aimed at testing which variables were found to be predictors of students’ self-reported formal outsourcing behaviours. The data are derived from an international research study conducted in 22 languages, with higher education students (from Europe, the Americas and Australasia. Analyses found that country and discipline of study as well as the rate at which respondents n = 7806) believed other students to be cheating, were positively correlated to their cheating behaviours. Demographic variables did not show strong statistical significance to predicting contract cheating. (shrink)

Many social scientists and philosophers have counted themselves moral relativists in some sense or other. We cannot deal with all the various views which are properly called forms of “moral relativism”; so I propose to explain a form of moral relativism which seems to me an interesting, and somewhat plausible theory. This theory comprises the following three affirmations: The basic moral principles of different individuals or groups sometimes are, or can be, in some important sense conflicting. When there is such (...) fundamental conflict of basic principles or standards, there is either always, or at least sometimes, no way to show that one view is better justified even in the presence of ideally complete factual information; in that sense the principles are equally justified or “valid.” But there is a sense in which a particular moral belief may be mistaken or unjustified, if it is a misapplication of the basic principles of the individual or group, e.g., if the basic principles plus statements of known or knowable facts entail a moral proposition incompatible with it. As stated, moral relativism could be true even though in fact, accidentally, all individuals agree in their basic moral principles. (shrink)

It is the aim of this paper to examine certain aspects of a point of view which has attracted much attention in physical methodology. This is the standpoint known as operationalism. We wish to discuss its significance in the construction and interpretation of physical theories.The essential meaning of operationalism in physics is that physical concepts should be defined in terms of actual physical operations. On this view there is no meaning to a concept unless it represents an operation which can (...) be performed in the laboratory. Thus the term “pressure of a gas” signifies nothing until an operation is described which constitutes the measurement of pressure. When one thinks of pressure one must think. of some actual apparatus, such as, for example, some glass and rubber tubing and some mercury and certain operations performed using these until finally one gets a pointer reading which one calls the pressure of the gas. The same stand is taken with respect to length, time, velocity, acceleration, temperature, etc. (shrink)

I describe how gravitational entropy is intimately connected with the concept of gravitational heat, expressed as the difference between the total and free energies of a given gravitational system. From this perspective one can compute these thermodyanmic quantities in settings that go considerably beyond Bekenstein's original insight that the area of a black hole event horizon can be identified with thermodynamic entropy. The settings include the outsides of cosmological horizons and spacetimes with NUT charge. However the interpretation of gravitational entropy (...) in these broader contexts remains to be understood. (shrink)

One area in which the moral philosopher might say something useful for the thinking of economists is that of welfare economics – not by improving formalizations or criticizing proofs as to conditions necessary or sufficient for an optimum situation, much less by suggesting what particular state of society would be optimal. Rather, he can do this by pointing out some distinctions, by suggesting how some terms used by economists can profitably be defined, and by questioning some assumptions which seem to (...) lie behind the thinking of some economists. The following discussion is aimed along these lines. The main goal of the argument will be to produce helpful definitions of “increase the welfare of an individual” and “increase social welfare.”. (shrink)

The approach to teaching employed in the Dictionary of Medical Ethics (1) provides a model which might be adopted in other media. Most of the 150 authors were medical, but many represented other disciplines, and they wrote for similar professionals and for the general public. Medical ethics is derived from medical science and practice, moral philosophy, sociology, theology, the law and other disciplines, all of which make essential, distinctive and complementary contributions to knowledge and to teaching. Medical practitioners must play (...) the primary role, because they are responsible for clinical ethical decisions, but they need the co-operation and guidance of others. All who are concerned should work towards the development of a general moral consensus among the profession and public, which keeps abreast of scientific and technical advances and to which all are committed. (shrink)