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 their 2008 paper, Persson and Savulescu suggest that for moral bioenhancement (MBE) to be effective at eliminating the danger of ‘ultimate harm’ the intervention would need to be compulsory. This is because those most in need of MBE would be least likely to undergo the intervention voluntarily. By drawing on concepts and theories from epidemiology, this paper will suggest that MBE may not need to be universal and compulsory to be effective at significantly improving the collective moral standing of (...) a human populace and reducing the threat of ultimate harm. It will identify similarities between the mechanisms that allow biological contagions (such as a virus) and behaviours (such as those concerned with ethical and unethical actions) to develop, spread, and be reinforced within a population. It will then go onto suggest that, just as with the epidemiological principle of herd immunity, if enough people underwent MBE to reach a minimum threshold then the incidence and spread of immoral behaviours could be significantly reduced, even in those who have not received MBE. (shrink)

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.

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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)

It is a common complaint against moral philosophers that their abstract theorising bears little relation to the practical problems of everyday life. Professor Braithwaite believes that this criticism need not be inevitable. With the help of the Theory of Games he shows how arbitration is possible between two neighbours, a jazz trumpeter and a classical pianist, whose performances are a source of mutual discord. The solution of the problem in the lecture is geometrical, and is based on the formal analogy (...) between the logic of the situation and the geometry of a parabola. But an appendix provides the alternative algebraic treatment of a general two-person collaboration situation. (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)

In the fourteenth century William of Occam in the course of his attack on the medieval scholastic philosophy enunciated his famous “razor”: Entia non sunt multiplicanda praeter necessitatem. This is the classic claim for the description of nature in terms of the minimum possible number of fundamental concepts. It was presumably so recognized by Newton in the third book of his “Principia” in 1687 when he wrote: “We are to admit no more causes of natural things than such as are (...) both true and sufficient to explain their appearances. To this purpose the philosophers say that Nature does nothing in vain, and more is in vain when less will serve; for Nature is pleased with simplicity and affects not the pomp of superfluous causes.”. (shrink)