Moral distress has been identified as an occupational hazard for clinicians caring for vulnerable populations. The aim of this systematic review was (i) to summarize the literature reporting on prevalence of, and factors related to, moral distress among nurses within acute mental health settings, and (ii) to examine the efficacy of interventions designed to address moral distress among nurses within this clinical setting. A comprehensive literature search was conducted in October 2022 utilizing Nursing & Allied Health, Embase, CINAHL, PsychInfo, and (...) PubMed databases to identify eligible studies published in English from January 2000 to October 2022. Ten studies met inclusion criteria. Four quantitative studies assessed moral distress among nurses in acute mental health settings and examined relationships between moral distress and other psychological and work-related variables. Six qualitative studies explored the phenomenon of moral distress as experienced by nurses working in acute mental health settings. The quantitative studies assessed moral distress using the Moral Distress Scale for Psychiatric Nurses (MDS-P) or the Work-Related Moral Stress Questionnaire. These studies identified relationships between moral distress and emotional exhaustion, depersonalization, cynicism, poorer job satisfaction, less sense of coherence, poorer moral climate, and less experience of moral support. Qualitative studies revealed factors associated with moral distress, including lack of action, poor conduct by colleagues, time pressures, professional, policy and legal implications, aggression, and patient safety. No interventions targeting moral distress among nurses in acute mental health settings were identified. Overall, this review identified that moral distress is prevalent among nurses working in acute mental health settings and is associated with poorer outcomes for nurses, patients, and organizations. Research is urgently needed to develop and test evidence-based interventions to address moral distress among mental health nurses and to evaluate individual and system-level intervention effects on nurses, clinical care, and patient outcomes. (shrink)

This is probably an overly ambitious Syllabus for a ten week seminar. I regard the early part of the Syllabus (roughly, §§1-9) as pretty fixed. We may have to choose among the later topics (§§10- 12), and I welcome student input on these decisions. Required readings are preceded by `(A)`; recommended readings are preceded by `(B)`. Full references are available on the Select Bibliography. Most of the required readings come from the required texts. Required readings not found in the required (...) texts, and some recommended readings, can be found on Electronic Reserves. If you have trouble locating any of the recommended readings, let me know; I can try to help. (shrink)

This paper addresses the question of the role of ostracism in democratic Athens. I argue that the frequent expulsion of aristocrats by rival aristocrats in the predemocratic polis is the key to understanding the function of ostracism in the democratic polis. I show that aristocratic "politics of exile" was a fundamental political problem in the archaic polis and that democratic political power, symbolized by the institution of ostracism, was the polis' solution to the problem. In the archaic polis, the expulsion (...) of aristocrats often led to an endless cycle of exiles and returns and consequent political instability. In 508/7, the Athenian demos usurped the power over decisions of exile by banishing Isagoras and recalling Cleisthenes from exile. By taking control of decisions of exile, the Athenian demos took over political power insofar as power over decisions of exile had become synonymous with political power. The creation of the institution of ostracism, whereby the people decided collectively whether to banish a single citizen for ten years, provided not only a mechanism for the symbolic expression of democratic power, but also a means for the practical and ideological distinction between oligarchic and democratic rule. While aristocrats had banished their opponents without limit in numbers and duration of exile, the Athenian democracy decided each year whether to banish a single individual for a limited time period. In most years, the Athenian demos chose not to exercise the power of exile. Nevertheless, the annual question in the assembly served to remind aristocrats that the demos held the fundamental political power, and hence deterred aristocrats from attempting to overthrow the democracy. The limited nature of ostracism further deterred exiled aristocrats from attempting to return by force. Finally, the infrequent and moderate use of exile as a means of resolving political conflict helps to explain the extraordinary stability of the Athenian democracy. (shrink)

The emotion of anger, when chronic, is especially problematic. Frequent and intense experiences of anger predict quite a few adverse health outcomes and are especially implicated in cardiovascular...

Background: Caring for a partner with primary malignant brain tumour can be a dramatic life-changing event. Primary malignant brain tumour is known to give poor life expectancy and severe neurological and cognitive symptoms, such as changed behaviour and personality, which demand greater caring responsibilities from spouses. Aim: The aim of the study is to explore ethical dilemmas spouses experience in the everyday care of a partner in treatment for primary malignant brain tumour. Research design, participants and research context: A phenomenological (...) and hermeneutic qualitative descriptive design was adopted as a method for collecting and analysing data. Ten spouses were interviewed twice using an in-depth, semi-structured interview guide. The interviews took place at the spouses’ homes or at the hospital. Ethical consideration: Ethical matters were considered throughout the research process. Permission from The National Committee on Health Research Ethics and the Danish Data Protection Agency was obtained. Findings: The analysis showed that the spouses perceived daily ethical dilemmas in caring for a partner with primary malignant brain tumour. Their life as well as their partner’s life had changed considerably. The main theme that emerged therefore was ‘oscillating in a changing relationship’. This theme was further elaborated in three subthemes that in more detail demonstrated the dilemmas: ‘doing the right thing in unpredictable daily situations’; ‘torn between patience and guilt’; and ‘living in a time of uncertainty, hope and despair’. Conclusion: Caring for a partner with changed behaviour and personality due to primary malignant brain tumour may involve exhausting ethical caring dilemmas. Spouses’ married life may change to a semi-professional asymmetrical relationship, which is challenged by the oscillation between acting responsibly for their partners’ well-being and caring dilemmas with no answer for what the right thing to do is. Mixed feelings of right and wrong, patience and guilt, hope and despair seem to be spousal companions through their partners’ progressing illness. (shrink)

IntroductionDignity therapy is brief psychotherapy targeting psychological and existential suffering among patients with a life-limiting illness. Studies have been conducted on the use of DT by healthcare professionals. In Italy, the current legislation defines that any form of psychotherapy may be performed exclusively by psychotherapists. Consequently, this intervention is unlikely to be used by other healthcare professionals. Herein, we will describe a training on DT not as a psychotherapy intervention but as a narrative intervention for non-psychotherapists health care professionals. Finally, (...) we will explore the potential enablers/barriers as experienced by palliative care physicians and nurses.MethodsThe study was conducted in the Psycho-Oncology Unit within the Cancer Research Hospital of Reggio Emilia. It consisted of an exploratory qualitative case study. Data were collected employing observations and interview data and thematically analyzed.ResultsThe training was attended by six physicians and ten nurses and took place during two-afternoon sessions for 10 h. Two participants put their training into practice and administered DT under the supervision of a psychotherapist. Data analysis highlighted five overarching themes relating to the training experience and direct use of DT, namely, time required, psychological skills, patient’s disease awareness, patient’s life history, and distinguishing DT from Advance Care Planning.ConclusionPalliative care professionals found DT to be a valuable non-pharmacological hospital-based intervention to address the person beyond the patient and his clinical conditions. In our experience, considering that in Italy, psychotherapy is an intervention that psychotherapists can only perform, it can help organize different training on DT for psychotherapists and other healthcare professionals. (shrink)

This study examined the potential for a new area of corporate social responsibility washing: gender equality. Companies are increasingly recognized for advertisements promoting gender equality, termed “femvertisements.” However, it is unclear whether companies that win femvertising awards actually support women with an institutionalized approach to gender equality. A quantitative content analysis was performed assessing company leadership team listings, annual reports, CSR reports, and CSR websites of 61 US-based companies to compare the prevalence of internal and external gender-equality CSR activities of (...) companies that have won femvertising awards. When controlling for number of employees and annual revenue, award-winning companies committed to more internal efforts that support women than non-award-winning companies. However, no significant differences were found in the number of external efforts or representation in female leadership between companies with and without award-winning femvertisements. Overall, a majority of award-winning companies engaged in less than ten of the possible 23 gender-equality CSR activities, suggesting these companies’ female empowerment commercials were often not in line with their broader CSR activities. While more research is needed in this area, we propose the term “fempower-washing” to describe CSR-washing in the context of gender equality. (shrink)

Background Abortion is one of the most common gynaecological procedures. It is related to personal, social, and economic reasons under a legal term that is recognised as a common sexual and reproductive right in most of countries. However, making the decision to abort is complex, because it is politicised and is often framed in public discourse related to moral or ethical issues beyond women’s experiences. Therefore, it is subject to medical criteria, religious evaluations, and sociological analysis. Purpouse The aim of (...) this synthesis of qualitative studies was to synthesise the decision-making experiences of women who legally aborted. Research design and method The Noblit and Hare’s interpretive meta‐ethnography was conducted, and it was written in accordance with the eMERGe meta‐ethnography reporting guidance. Ten studies met the research objective and inclusion criteria, after a comprehensive systematic search strategy in five databases. Findings The metaphor “The wrestling between why and what will happen next” and three themes emerged from the data analysis: (1) Forces that incite the arm wrestling; (2) Facing social stigma; and (3) Defeated by a greater rival. The metaphor provided interpretive experiences of the moral conflict experienced by women who decided to have an abortion and emerged from the confrontation of the reasons why they decided to abort and the social repercussions that making the decision entails. The result of the struggle was loneliness and vulnerability. Conclusion The lines of action impact policy makers, the media, and health professionals. Actions should focus on the de-stigmatisation and normalisation of abortion, the use of appropriate language, and the training and sensitisation of health professionals. (shrink)

In Vanuatu, small-scale farmers’ subsistence still largely relies on the sustainable use and maintenance of a wide-ranging biodiversity out of which root and tuber crops provide the bulk of daily subsistence. In neighboring countries, foreign influence since the first European contacts, further associated changes and the introduction of new crop species have induced a loss of cultivated diversity. This paper presents a baseline study of the diversity of root and tuber crops in ten communities throughout Vanuatu. In a context where (...) the smallholders’ agrosystems are increasingly considered as key components for the global conservation of crop genetic resources, this study provides clues to better understand the effective roles of biodiversity in traditional agrosystems. It also provides insights on the rationale behind the constitution of agricultural portfolios and discusses how the cultivated diversity allows communities to cope with changes and pressures. The paper also shows that recently introduced crops neither seem to have compromised agricultural diversity nor drastically changed the agrosystems in Vanuatu. On the contrary, such crops are used by farmers to strengthen the resilience of their agrosystems. A discussion then presents the idea of continuity through change and novelty as a critical factor for resilience. The paper concludes by discussing the role of indigenous agriculture and culture in ensuring food security and in development strategies in a larger context. (shrink)

The format of this volume in the Library of Living Philosophers series provides for a detailed interaction between those who interpret and critique Julia Kristeva's work and Kristeva herself, giving broad coverage, from diverse viewpoints, of all the major topics establishing her reputation. This work begins with her autobiography, which provides an excellent introduction to her work, situating it in relation to major political, intellectual, and cultural movements of the time. The major part of the book is comprised of thirty-six (...) essays by Kristeva's foremost interpreters and critics, together with her replies to the essays. These encounters cover an exceptionally wide range of theoretical and literary writing. The strong international and multidisciplinary focus includes authors from over ten countries, and spans the fields of philosophy, semiotics, literature, psychoanalysis, feminist thought, political theory, art, and religion. A comprehensive bibliography of works by Kristeva is included. (shrink)

Background Research is crucial to improve treatment, survival and quality of life for children with cancer. However, recruitment of children for research raises ethical challenges. The aim of this study was to explore and describe ethical values and challenges related to the recruitment of children with cancer for research, from the perspectives and experiences of healthcare professionals in the Swedish context. Another aim was to explore their perceptions of research ethics competence in recruiting children for research. Methods An explorative qualitative (...) study using semi-structured interviews with key informants. Seven physicians and ten nurses were interviewed. Interviews were analysed using inductive qualitative content analysis. Results The respondents’ ethical challenges and values in recruitment mainly concerned establishing relationships and trust, meeting informational needs, acknowledging vulnerability, and balancing roles and interests. Ensuring ethical competence was raised as important, and interpersonal and communicative skills were highlighted. Conclusion This study provides empirical insight into recruitment of children with cancer, from the perspectives of healthcare professionals. It also contributes to the understanding of recruitment as a relational process, where aspects of vulnerability, trust and relationship building are important, alongside meeting informational needs. The results provide knowledge on the complexities raised by paediatric research and underpin the importance of building research ethics competence to ensure that the rights and interests of children with cancer are protected in research. (shrink)

In the past ten years, there has been growing interest in and concern about protecting the privacy of personal medical information. Insofar as medical records increasingly are stored electronically, and electronic information can be shared easily and widely, there have been legislative efforts as well as scholarly analyses calling for greater privacy protections to ensure that patients can feel safe disclosing personal information to their health-care providers. At the same time, the volume of biomedical research conducted in this country continues (...) to grow. The budget of the National Institutes of Health, for example, was $20,298 million in 2001, having more than doubled from a budget of $9,218 million 10 years before. This growing body of research includes increased efforts to use stored medical records as a source of data for health services, epidemiologic, and clinical studies. (shrink)

Many of the things we do, we do together with other people. Think of carpooling and playing tennis. In the past two or three decades it has become increasingly popular to analyze such collective actions in terms of collective intentions. This volume brings together ten new philosophical essays that address issues such as how individuals succeed in maintaining coordination throughout the performance of a collective action, whether groups can actually believe propositions or whether they merely accept them, and what kind (...) of evidence, if any, disciplines such as cognitive science and semantics provide in support of irreducibly collective states.The theories of the Big Four of collective intentionality -- Michael Bratman, Raimo Tuomela, John Searle, and Margaret Gilbert -- and the Big Five of Social Ontology -- which in addition to the Big Four includes Philip Pettit -- play a central role in almost all of these essays. Drawing on insights from a wide range of disciplines including dynamical systems theory, economics, and psychology, the contributors develop existing theories, criticize them, or provide alternatives to them.Several essays challenge the idea that there is a straightforward dichotomy between individual and collective level rationality, and explore the interplay between these levels in order to shed new light on the alleged discontinuities between them. These contributions make abundantly clear that it is no longer an option simply to juxtapose analyses of individual and collective level phenomena and maintain that there is a discrepancy. Some go as far as arguing that on closer inspection the alleged discontinuities dissolve. (shrink)

IntroductionThis case study describes the process faculty at a large research university undertook to build a stand-alone online academic integrity course for first-year and transfer students. Because academic integrity is decentralized at the institution, building a more systematic program had to come from the bottom-up (faculty developed) rather than from the top down (institutionally mandated).Case descriptionUsing the learning management system, faculty and e-learning designers collaborated to build the course. Incorporating nuanced scenarios for six different types of misconduct (consistent with the (...) University’s Code of Student Rights, Responsibilities & Conduct), a pre- and post-test, and assessments for each scenario, the course provides experience in recognizing and avoiding academic misconduct.Discussion and evaluationAs a stand-alone course, the faculty who created it maintain control over content and are able to analyze student performance across the institution. In the ten months since its launch, the course has been eagerly adopted by faculty (n = 1853 students have completed the course) and post-test scores indicate students are learning from the course.ConclusionsAfter the successful launch of the student course, the next step, already underway, is the launch of learning modules for faculty and teaching assistants. (shrink)

This is a volatile time for health insurance policy. Medicare and Medicaid are in turmoil, as is the private health insurance market. Public and private health insurance costs constitute eighty percent of healthcare spending in the United States. Public health professionals depend on the insurance system to behave in ways that are responsive to public health in prevention and crisis management.Seventy-five percent of the American population, excluding the elderly, has coverage through the private health insurance system. Ninety percent of this (...) group receives their insurance through employer-sponsored programs, and the remaining ten percent buy their own coverage. Approximately ten percent of the non-elderly population has insurance through a government program, and fifteen percent of the non-elderly population, almost forty-one million Americans, is uninsured. (shrink)

De uitvoerige reactie van Sarot en Van den Brink waarin ze hun ‘Utrechtse’ positie in de wijsgerige theologie verduidelijken en verdedigen tegenover mijn vragen en scepsis, zou een uitvoerige beantwoording verdienen, uitvoeriger en grondiger dan het mij op deze plaats mogelijk is. Ik zal, ten eerste, ingaan op de kwestie van het realisme en, ten tweede, op het verwijt van ‘agnosticisme’ aan mijn adres.

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Embodying Contagion: The Viropolitics of Horror and Desire in Contemporary Discourse ed. by Sandra Becker, Megen de Bruin-Molé, and Sara PolakLars SchmeinkSandra Becker, Megen de Bruin-Molé, and Sara Polak, editors. Embodying Contagion: The Viropolitics of Horror and Desire in Contemporary Discourse. Bangor, Wales: The University of Wales Press, 2021. PB, p. 288, ISBN 978-1-78683-690-8, GBP 45,-There is a trend in current humanities writing to point out (...) its relation to the ongoing COVID-19 pandemic, curious on the one hand as we normally do not address the day-to-day of our contemporary moment in time quite as immediately, reasonably needing a few years to position our thinking against the fickleness of the Zeitgeist. But, on the other hand, the pandemic has had such a profound impact on all the work we have been doing that it seems impossible not to mention—from projects cancelled or changed due to travel restrictions and lockdowns or to issues becoming so much more (or sometime less) important as our academic as well as social priorities shift. Embodying Contagion, a volume of collected essays, was already in the process of editorial work when the pandemic struck; in fact, it was already in the final round of edits (xiii). But how would you edit a collection on contagion narratives and not address the big one unfolding right then and there? So, in a way this volume is made even more timely because of its peculiar moment of publication, as the ongoing health crisis of COVID-19 is entering its next stage, and somehow the essays needed to position themselves against this historical backdrop—this, the experience of living through a contagion narrative, is then interwoven into the volume like a thread. [End Page 515]In terms of its original premise, the volume has not lost its pertinence; if anything, it is heightened. In a nutshell, the volume takes up the mantle from Priscilla Wald, who had coined the term "outbreak narrative" and expands it to the idea of "contagion" (1–2), discussing the "viropolitics of horror and desire" (2) linked to these contagions as metaphors and images to cope with social realities. As the editors attest, the fascination with contagion in our culture is omnipresent—more so after COVID-19—and can be read to determine our bodies as posthuman, existing "as shifting and sharing ecosystems rather than isolated and inviolate objects, contemporary culture unveils a seemingly endless series of new ways to be, to behave and to belong alongside other bodies" (3). Contagion narratives reveal our relational existence—through them, "we negotiate the boundaries between bodies that are welcome, bodies that must be confined or silenced, and bodies that must be eradicated" (4). It is this negotiation that is framed as key cultural work in the volume and that the ten essays interrogate—why do we use contagion to explore our relational selves, to each other and to our surroundings?In terms of structure, the essays are divided into two main parts with five essays each, framed by a preface from the inspirational Priscilla Wald, an introduction laying out the idea of the volume, and a centrally important epilogue that addresses the current pandemic and its impacts as a contagion narrative specifically. In her preface, Wald is adamant in sounding the alarm, or better yet sounding out a profound "I told you so" as she discusses how "woefully underprepared" (xvii) we were for the pandemic and how ignored contagions are politically—making clear in the process that the cultural work of these narratives is more pressing to recognize: "As these stories titillate us, they shape experience: who, what and where a culture locates its threats, its definitions of 'us' and 'them,' its response to other cultures and to the planet" (xvii).The first part of the volume, then, addresses "the role of epidemic fantasies in theory and reality" (4), meaning that news reporting, policy measures, or social media take up metaphors and imagery of contagion, generating meaning around these narratives. Consequently, in terms of its interdisciplinary approach, the chapters in this part of the volume are closely related to sociology and communication studies, as... (shrink)

Ten years after the Human Genome Project’s completion the life sciences stand in a moment of uncertainty, transition, and contestation. The postgenomic era has seen rapid shifts in research methodology, funding, scientific labor, and disciplinary structures. Postgenomics is transforming our understanding of disease and health, our environment, and the categories of race, class, and gender. At the same time, the gene retains its centrality and power in biological and popular discourse. The contributors to Postgenomics analyze these ruptures and continuities and (...) place them in historical, social, and political context. Postgenomics, they argue, forces a rethinking of the genome itself, and opens new territory for conversations between the social sciences, humanities, and life sciences. Contributors. Russ Altman, Rachel A. Ankeny, Catherine Bliss, John Dupré, Michael Fortun, Evelyn Fox Keller, Sabina Leonelli, Adrian Mackenzie, Margot Moinester, Aaron Panofsky, Sarah S. Richardson, Sara Shostak, Hallam Stevens. (shrink)

Envy is almost universally condemned. But is its reputation warranted? Sara Protasi argues envy is multifaceted and sometimes even virtuous.

Advancements in novel neurotechnologies, such as brain computer interfaces and neuromodulatory devices such as deep brain stimulators, will have profound implications for society and human rights. While these technologies are improving the diagnosis and treatment of mental and neurological diseases, they can also alter individual agency and estrange those using neurotechnologies from their sense of self, challenging basic notions of what it means to be human. As an international coalition of interdisciplinary scholars and practitioners, we examine these challenges and make (...) recommendations to mitigate negative consequences that could arise from the unregulated development or application of novel neurotechnologies. We explore potential ethical challenges in four key areas: identity and agency, privacy, bias, and enhancement. To address them, we propose democratic and inclusive summits to establish globally-coordinated ethical and societal guidelines for neurotechnology development and application, new measures, including “Neurorights,” for data privacy, security, and consent to empower neurotechnology users’ control over their data, new methods of identifying and preventing bias, and the adoption of public guidelines for safe and equitable distribution of neurotechnological devices. (shrink)

The debate on love's reasons ignores unrequited love, which—I argue—can be as genuine and as valuable as reciprocated love. I start by showing that the relationship view of love cannot account for either the reasons or the value of unrequited love. I then present the simple property view, an alternative to the relationship view that is beset with its own problems. In order to solve these problems, I present a more sophisticated version of the property view that integrates ideas from (...) different property theorists in the love literature. However, even this more sophisticated property view falls short in accounting for unrequited love's reasons. In response, I develop a new version of the property view that I call the experiential view. On this view, we love a person not only in virtue of properties shaped by and experienced in a reciprocal loving relationship, but also in virtue of perspectival properties, whose value can be properly assessed also outside of a reciprocal loving relationship. The experiential view is the only view that can account not only for reciprocated love's reasons, but also for unrequited love's reasons. (shrink)

This paper gives a framework for understanding causal counterpossibles, counterfactuals imbued with causal content whose antecedents appeal to metaphysically impossible worlds. Such statements are generated by omissive causal claims that appeal to metaphysically impossible events, such as “If the mathematician had not failed to prove that 2+2=5, the math textbooks would not have remained intact.” After providing an account of impossible omissions, the paper argues for three claims: (i) impossible omissions play a causal role in the actual world, (ii) causal (...) counterpossibles have broad applications in philosophy, and (iii) the truth of causal counterpossibles provides evidence for the nonvacuity of counterpossibles more generally. (shrink)

Episodic and semantic memory are often taken to be fundamentally different mental systems, and contemporary philosophers often pursue research questions about episodic memory, in particular, in isolation from semantic memory. This paper challenges that assumption, and puts pressure on philosophical approaches to memory that break off episodic memory as its own standalone topic. I present and systematize psychological and neuroscientific theories of semanticization, the thesis that memory content tends to drift from episodic to semantic in structure over time and exposure (...) to an environment. Semanticization, I argue, is a long-term interconnection between episodic and semantic systems that requires approaching both the content and function of these two memory systems as a whole. Thus we have a reason to reject projects by Michael Martin, which aims to carve out a uniquely episodic memory content, and Kourken Michaelian, which pairs episodic memory to its own unique function. Instead, seeing declarative memory as a single system with two facets or even a continuum of features allows for deeper insight into both content and function. (shrink)