Background: Most previous studies on moral distress focused on the factors that cause moral distress, paying inadequate attention to the moral conflict of nurses’ values, the physician–nurse power hierarchy, and the influence of the culture. Research objective: To analyze the main causes for moral distress with interpretive interactionism. Research design: A qualitative study was adopted. Participants: Through purposeful sampling, 32 nurses from 12 different departments were chosen as the samples. Ethical considerations: Approval from the Institutional Review Board of the Kaohsiung (...) Medical University Hospital. Findings: Moral distress is likely to occur in the following clinical situations: patients have no idea about their diseases; the medical decisions fail to meet the optimum benefit of patients; and patients with terminal cancers are not given a proper death. The reason why nurses become trapped in moral distress is that they fail to achieve moral goodness. Inadequate confidence, the physician–nurse power hierarchy, and the Oriental culture affect nurses’ goodness-based intention for patients, which deteriorates moral distress. Discussion: The main cause for moral distress is the moral goodness of nurses. If nurses’ goodness-based intention for patients is inconsistent with the moral objective of achieving optimum benefit for patients, it leads to moral distress. Culture is an essential background factor of care for patients. In the Oriental culture, family members influence patients’ right to know about their diseases, the choice of treatment, and patients’ autonomy of not receiving cardio-pulmonary resuscitation. This results in moral distress in medical care. Conclusion: The occurrence of moral distress demonstrates that nurses have moral characteristics such as goodness and caring. It is suggested that appropriate educational strategies can be adopted to weaken the power hierarchy between physicians and nurses and enhance nurses’ confidence and cultural sensitivity, so as to reduce the moral distress of nurses. (shrink)

Background: People in both Taiwan and China originally descended from the Han Chinese, but the societies have been separated for approximately 38 years. Due to different political systems, variations exist in healthcare and nursing education systems in Taiwan and China. Objective: The purpose of this study was to examine the professional values of nursing students in Taiwan and China. Design: A cross-sectional design was applied in this study. The Nursing Professional Value Scale–Revised was used to measure the professional values of (...) the students. The questionnaire was distributed to eligible undergraduate students in a classroom setting. Ethical considerations: This study was approved by the Institutional Review Board at the first investigator’s university. Participants were informed that completion and return of the questionnaire was voluntary, and confidentiality was ensured by keeping the responses anonymous. Participants: A convenience sample included 292 Taiwanese students and 654 Chinese students. Findings: A total of 11 individual Nursing Professional Value Scale–Revised items showed significant differences between the two groups. These results reflect the differences in the perceived importance of these items between the groups. There was no significant difference between the two groups in the mean overall scores for the Nursing Professional Value Scale–Revised (p =.766) and three subscales (all p >.05). Conclusion: There are some differences in professional values between nursing students in Taiwan and China. Given the increasingly frequent and close interactions between Taiwan and China and the globalization of nursing, understanding these differences may help nursing educators identify students’ perceptions of their professional values and support the development of strategies to improve weaknesses in professional values. (shrink)

The “social-political-hierarchical” qualifications have long been identified as the essential features of the Confucian golden rule. This essay challenges this prevailing characterization by revealing the relation and differences between Confucius’ original shu 恕 and a series of post-Confucius reformulations in ancient Confucianism. Specifically, the premise of equality, which underlies Confucius’ formulation of shu in correlation with ren 仁, rendered shu incompatible with asymmetrical relationships. Besides the advantage of overcoming this limitation by adapting the golden rule structure of shu to specified (...) asymmetrical relationships, the post-Confucius formula, especially “the measuring square” in the Great Learning, was devised to guide one to infer universalizable rules of conduct for various roles in diverse relationships. On this basis, I demonstrate a pivotal shift in the golden rule practice of ancient Confucianism—a shift of focus from its correlation with ren to its conformity with li 禮 as the system of rules of conduct and the principle of “discriminations.”. (shrink)

Abstract Up to now Chinese academia has been addicted to inviting the twin goddesses of democracy and science, but has regrettably ignored the innate incongruity between them, which has led to the rise of scientism. May 4th pioneers first introduced this value system, but tension between these values subsequently led to a prevailing preference for science over freedom. The early Marxists defined freedom as obedience to social laws formulated in Marxist ?science?, while Maoism finalized the Sinicization of Marxism with a (...) belief in iron?bound social laws and in human beings as mere political means, mercilessly suppressing any expression of free will. (shrink)

Online social network services have brought a kind of new lifestyle to the world that is parallel to people’s daily offline activities. Social network analysis provides a useful perspective on a range of social computing applications. Social interaction on the Web includes both positive and negative relationships, which is certainly important to social networks. The authors of this article found that the accuracy of the signs of links in the underlying social networks can be predicted. The trust that other users (...) impart on a node is an important attribute of networks. In this article, the authors present a model to compute the prestige of nodes in a trust-based network. The model is based on the idea that trustworthy nodes weigh more. To fulfill this task, the authors first attempt to infer the attitude of one user toward another by predicting signed edges in networks. Then, the authors propose an algorithm to compute the prestige and trustworthiness where the edge weight denotes the trust score. To prove the algorithm’s effectiveness, the authors conducted experiments on the public dataset. Theoretical analysis and experimental results show that this method is efficient and effective. (shrink)

Auditory warnings have been shown to interfere with verbal working memory. However, the impact of different types of auditory warnings on working memory tasks must be further researched. This study investigated how different kinds of auditory warnings interfered with verbal and spatial working memory. Experiment 1 tested the potential interference of auditory warnings with verbal working memory. Experiment 2 tested the potential interference of auditory warnings with spatial working memory. Both experiments used a 3 × 3 mixed design: auditory warning (...) type was between groups, and task condition was within groups. In Experiment 1, earcons and spearcons but not auditory icons worsened the performance on the verbal serial recall task in the identify-warning condition, compared with that in the no-warning or ignore-warning conditions. In Experiment 2, only identifying earcons worsened the performance on the location recall task compared with performance without auditory warnings or when auditory warnings were ignored. Results are discussed from the perspective of working memory resource interference, and their practical application in the selection and design of auditory warning signals is involved. (shrink)

The potential of ChatGPT looms large for the practice of medicine, as both boon and bane. The use of Large Language Models (LLMs) in platforms such as ChatGPT raises critical ethical questions of w...

The purposes of research were to describe the neonatal clinicians' personal views and attitudes on neonatal ethical decision-making, to identify factors that might affect these attitudes and to compare the attitudes between neonatal physicians and neonatal nurses in Taiwan. Research was a cross-sectional design and a questionnaire was used to reach different research purposes. A convenient sample was used to recruit 24 physicians and 80 neonatal nurses from four neonatal intensive care units in Taiwan. Most participants agreed with suggesting a (...) do not resuscitate (DNR) order to parents for dying neonates (86.5%). However, the majority agreed with talking to patients about DNR orders is difficult (76.9%). Most participants agree that review by the clinical ethics committee is needed before the recommendation of ‘DNR’ to parents (94.23%) and nurses were significantly more likely than physicians to agree to this (p=0.043). During the end-of-life care, most clinicians accepted to continue current treatment without adding others (70%) and withholding of emergency treatments (75%); however, active euthanasia, the administration of drug to end-of-life, was not considered acceptable by both physicians and nurses in this research (96%). Based on our research results, providing continuing educational training and a formal consulting service in moral courage for neonatal clinicians are needed. In Taiwan, neonatal physicians and nurses hold similar values and attitudes towards end-of-life decisions for neonates. In order to improve the clinicians' communication skills with parents about DNR options and to change clinicians' attitudes for providing enough pain-relief medicine to dying neonates, providing continuing educational training and a formal consulting service in moral courage are needed. (shrink)

Conditional automated driving [level 3, Society of Automotive Engineers ] requires drivers to take over the vehicle when an automated system’s failure occurs or is about to leave its operational design domain. Two-stage warning systems, which warn drivers in two steps, can be a promising method to guide drivers in preparing for the takeover. However, the proper time intervals of two-stage warning systems that allow drivers with different personalities to prepare for the takeover remain unclear. This study explored the optimal (...) time intervals of two-stage warning systems with insights into the drivers’ neuroticism personality. A total of 32 drivers were distributed into two groups according to their self-ratings in neuroticism. Each driver experienced takeover under the two-stage warning systems with four time intervals. The takeover performance and subjective opinions for time intervals and situation awareness were recorded. The results showed that drivers in the 5-s time interval had the best takeover preparation. Furthermore, both the 5- and 7-s time intervals resulted in more rapid takeover reactions and were rated more appropriate and useful than the 3- and 9-s time intervals. In terms of personality, drivers with high neuroticism tended to take over immediately after receiving takeover messages, at the cost of SA deficiency. In contrast, drivers with low neuroticism responded safely by judging whether they gained enough SA. We concluded that the 5-s time interval was optimal for drivers in two-stage takeover warning systems. When considering personality, drivers with low neuroticism had no strict requirements for time intervals. However, the extended time intervals were favorable for drivers with high neuroticism in developing SA. The present findings have reference implications for designers and engineers to set the time intervals of two-stage warning systems according to the neuroticism personality of drivers. (shrink)

ABSTRACT This study seeks exploration of how employees’ moral identity is related to voice behavior in the current organizational dynamics. By integrating the self-consistency theory with a situational strength perspective, a moderated mediation model was constructed to examine connections among moral identity, leader secure-base support, work engagement, and voice behavior. Surveys were collected at 2 time points, 1 month apart, from 206 full-time employees in various organizations and industries in Taiwan. Supporting results indicated that employees’ moral identity was positively related (...) to voice behavior. The mediating impact of work engagement as a motivational mechanism between moral identity and voice behavior was observed. Relative to when LSBS was low, the effect of moral identity on work engagement and the indirect effect of moral identity on voice behavior through work engagement were more substantial when LSBS was high. Academic and managerial implications were discussed. (shrink)

This study aims to disclose how the magnetic resonance imaging neuroimaging approach has been applied in education studies, and what kind of learning themes has been investigated in the reviewed MRI neuroimaging research. Based on the keywords “brain or neuroimaging or neuroscience” and “MRI or diffusion tensor imaging or white matter or gray matter or resting-state,” a total of 25 papers were selected from the subject areas “Educational Psychology” and “Education and Educational Research” from the Web of Science and Scopus (...) from 2000 to 2019. Content analysis showed that MRI neuroimaging and learning were studied under the following three major topics and nine subtopics: cognitive function, science education, and brain development. As for the type of MRI neuroimaging research, the most frequently used approaches were functional MRI, followed by structural MRI and DTI, although the choice of approach was often motivated by the specific research question. Research development trends show that the neural plasticity theme has become more prominent recently. This study concludes that in educational research, the MRI neuroimaging approach provides objective and empirical evidence to connect learning processes, outcomes, and brain mechanisms. (shrink)

The “Asian disease” problem (Tversky & Kahneman, 1981) demonstrated behaviour in contradiction to the invariance axiom of EU theory. However, the risky choice behaviour was simply seen by the equate-to-differentiate model as a choice between the best possible outcomes or a choice between the worst possible outcomes. It was then argued that a way in which frame influences choice is through the perceived difference between possible outcomes. A “judgement” task was designed to examine whether the knowledge of “the value difference (...) between each possible outcome and the certain outcome” will permit prediction of preference in the choice pattern related to the Asian disease problem. Participants were exposed to an anthrax disease problem (the original or probabilistic version of the Asian disease problem) and a SARS problem (the fuzzy version of the Asian disease problem). It was shown that the empirical evidence in relation to the Asian disease problem could be satisfactorily accounted for by the generalised weak dominance strategy revealed by the judgement results. (shrink)

We agree with the critique of the Residual Normality assumption. Moreover, we challenge monolithic views of functional normality. Throughout life, development and adaptation require variations in cortical functional circuitry within and across individuals. We propose the principle of “coconstructed functionality” which maintains that brain-behavior functional correspondences are dynamically coproduced by neurobiological, experiential, and contextual processes.

The hippocampus is known to be comprised of several subfields, but the developmental trajectories of these subfields are under debate. In this study, we analyzed magnetic resonance imaging data from a cross-sectional sample using an automated segmentation tool to delineate the development of the hippocampal subregions from 6 to 26 years of age. We also examined whether gender and hemispheric differences influence the development of these subregions. For the whole hippocampus, the trajectory of development was observed to be an inverse-u. (...) A significant increase in volume with age was found for most of the subregions, except for the L/R-parasubiculum, L/R-fimbria, and L-HATA. Gender-related differences were also found in the development of most subregions, especially for the hippocampal tail, CA1, molecular layer HP, GC-DG, CA3, and CA4, which showed a consistent increase in females and an early increase followed by a decrease in males. A comparison of the average volumes showed that the right whole hippocampus was significantly larger, along with the R-presubiculum, R-hippocampal-fissure, L/R-CA1, and L/R-molecular layer HP in males in comparison to females. Additionally, the average volume of the right hemisphere was shown to be significantly larger for the hippocampal tail, CA1, molecular layer HP, GC-DG, CA3, and CA4. However, for the presubiculum, parasubiculum, and fimbria, the left side was shown to be larger. In conclusion, the hippocampal subregions appear to develop in various ways from childhood to adulthood, with both gender and hemispheric differences affecting their development. (shrink)

While researchers have offered remonstration-oriented, reciprocal, voluntary, and gratitude-based accounts of political obligation in classical Confucianism, I argue that these interpretations are either in conflict with the textual evidence or merely scratch the surface of Confucius’ theory of political obligation without fully elaborating its essence. Instead, I demonstrate that the theory of political obligation in Confucianism is a specific argument from paternalistic gratitude in which the people’s political obligation is analogically compared to children’s grateful duty to their parents. Moreover, I (...) use the Confucian theory of paternalistic gratitude to critically examine China’s recent politics of political obligation in the wake of the 2008 Sichuan 四川 earthquake. Although the Confucian-sounding references, such as kindness and the parent-state analogy, figure into the CPC’s Gratitude Education campaign, the Party’s politics of political obligation does not meet the Confucian normative standard. Specifically, in the Confucian theory of paternalistic gratitude, the people will be grateful to a benevolent ruler without this feeling being demanded by the state. However, in the Gratitude Education campaign, the Party self-righteously exacted the earthquake survivors’ gratitude. Local dissidents were subject to the stigmatization of “ungratefulness” and faced political violence as a consequence. The case of the Gratitude Education campaign serves as another example of the CPC’s political use of Confucianism for its non-Confucian goals. (shrink)

Myelin oligodendrocyte glycoprotein antibody-associated disease is an immune-mediated demyelinating disease of the central nervous system that is present in both adults and children. The most common clinical manifestations are optic neuritis, myelitis, acute disseminated encephalomyelitis, and brainstem syndrome. Cerebral cortical encephalitis is a rare clinical phenotype of myelin oligodendrocyte glycoprotein antibody-associated disease, which usually begins with seizures, headaches, and fever, and may be misdiagnosed as viral encephalitis in the early stages. Herein, we report two typical MOG antibody -positive patients presenting (...) with CCE, both of whom presented with headache, fever, seizures, and who recovered completely after immunotherapy. In addition, we performed a systematic review of the present literature from the perspectives of population characteristics, clinical symptoms, MRI abnormalities, treatments, and prognosis. Among the patients reported in 25 articles, 33 met our inclusion criteria, with the age of onset ranging from 4 to 52 years. Most of the patients had seizures, headache, fever, and unilateral cortical lesions on brain MRI. For acute CCE, 30 patients were treated with high-dose intravenous methylprednisolone, and the symptoms of most patients were completely relieved after immunotherapy. This study reported our experience and lessons learned in the diagnosis and treatment of MOG-Ab-positive CCE and provides a systematic review of the literature to analyse this rare clinical phenotype. (shrink)

An adaptive neural network control problem is addressed for a class of nonlinear hydraulic servo-systems with time-varying state constraints. In view of the low precision problem of the traditional hydraulic servo-system which is caused by the tracking errors surpassing appropriate bound, the previous works have shown that the constraint for the system is a good way to solve the low precision problem. Meanwhile, compared with constant constraints, the time-varying state constraints are more general in the actual systems. Therefore, when the (...) states of the system are forced to obey bounded time-varying constraint conditions, the high precision tracking performance of the system can be easily realized. In order to achieve this goal, the time-varying barrier Lyapunov function is used to prevent the states from violating time-varying constraints. By the backstepping design, the adaptive controller will be obtained. A radial basis function neural network is used to estimate the uncertainties. Based on analyzing the stability of the hydraulic servo-system, we show that the error signals are bounded in the compacts sets; the time-varying state constrains are never violated and all singles of the hydraulic servo-system are bounded. The simulation and experimental results show that the tracking accuracy of system is improved and the controller has fast tracking ability and strong robustness. (shrink)

Two kinds of probability expressions, verbal and numerical, have been used to characterize the uncertainty that people face. However, the question of whether verbal and numerical probabilities are cognitively processed in a similar manner remains unresolved. From a levels-of-processing perspective, verbal and numerical probabilities may be processed differently during early sensory processing but similarly in later semantic-associated operations. This event-related potential (ERP) study investigated the neural processing of verbal and numerical probabilities in risky choices. The results showed that verbal probability (...) and numerical probability elicited different N1 amplitudes but that verbal and numerical probabilities elicited similar N2 and P3 waveforms in response to different levels of probability (high to low). These results were consistent with a level-of-processing framework and suggest some internal consistency between the cognitive processing of verbal and numerical probabilities in risky choices. Our findings shed light on possible mechanism underlying probability expression and may provide the neural evidence to support the translation of verbal to numerical probabilities (or vice versa). (shrink)

The idea that imperial Confucianism demands the commoners’ absolute political obedience is widespread. Although some scholars have tried to challenge this popular idea, they leave a theory of imperial Confucian political obligation unaddressed. By engaging with political propaganda of the Qing 清 dynasty, specifically The Amplified Instructions of the Sacred Edict, I argue that imperial Confucian political obligation is a theory of paternalistic gratitude. Accordingly, the commoners’ political obligation is conditioned upon the ruler’s parental benevolence, and as a matter of (...) history, this theory guided discursive interaction between the Qing court and the commoners. Indeed, when the empire’s policies made their lives difficult, the commoners tended to appeal to the public transcript of paternalistic gratitude to justify their political disobedience. Both in theory and practice, then, imperial Confucian political obligation is not absolute, but rather a conditional theory of paternalistic gratitude. (shrink)

In this project, we explore perceptions of the social and ethical implications of nanotechnology among US scientists who work at the nanoscale, and develop and pilot test an online training module to foster consideration of social and ethical implications in the lab. To meet our first goal, we drew qualitative insights from open-ended survey data collected from scientists affiliated with the National Nanotechnology Infrastructure Network. Our data suggest that while the survey participants responded positively to the idea that consideration of (...) SEI should be a part of the work they do, there was confusion about whether SEI refers to lab safety, research integrity, or something more. This is something we sought to address in the online training module that we developed based on that qualitative data and on feedback collected from experts in nanoethics and lab management. We then pilot tested the module with undergraduate students studying nanotechnology in the National Science Foundation’s Research Experiences for Undergraduates program and with scientists registered to use a National Nanotechnology Coordinated Infrastructure-funded microelectronics research lab. The undergraduate data suggested that students appreciated the SEI training but wished professors and scientists would begin integrating the ideas therein into coursework and mentoring. The scientist data suggested that the module increased understanding of “social and ethical implications,” increased the perceived need to implement SEI into workplace routines, and, interestingly, heightened perceptions of risk associated with the scientists’ own work. The practical and theoretical implications of this work are discussed. (shrink)

Photographs of celebrities or objects of two incompatible cultural meaning systems were selected as experimental stimuli. By investigating bicultural individuals' naming of these photographs, and then their selection of a culture- associated beverage in the presence of a piece of background music, the present study found a profound switching between different cultural frames in response to the romantic music of China or USA. The findings suggest that the responses to the musical cue evoke more responses with strong cultural associations for (...) a dominated culture than for a dominating culture. (shrink)

‘Neuroeconomics’ can be broadly defined as the research of how the brain interacts with the environment to make decisions that are functional given individual and contextual constraints. Deciphering such brain-environment transactions requires mechanistic understandings of the neurobiological processes that implement value-dependent decision making. To this end, a common empirical approach is to investigate neural mechanisms of reward-based decision making. Flexible updating of choices and associated expected outcomes in ways that are adaptive for a given task (or a given set of (...) tasks) at hand relies on dynamic neurochemical tuning of the brain’s functional circuitries involved in the representation of tasks, goals and reward prediction. Empirical evidence as well as computational theories indicate that various neurotransmitter systems (e.g., dopamine, norepinephrine, and serotonin) play important roles in reward-based decision making. In light of the apparent aging-related decline in various aspects of the dopaminergic system as well as the effects of neuromodulation on reward-related processes, this article focuses selectively on the literature that highlights the triadic relations between dopaminergic modulation, reward-based decision making, and aging. Directions for future research on aging and neuroeconomoics are discussed. (shrink)

This study investigates the effects of visual mnemonics and the methods of presenting learning materials on learning visually similar characters for Chinese-as-second-language (CSL) learners. In supporting CSL learners to build robust orthographic representations in Chinese, addressing the challenges of visual similarity of characters (e.g., 理 and 埋) is an important issue. Based on prior research on perceptual learning, we tested three strategies that differ in the extent to which they promote interrelated attention to the form and meaning of characters: (1) (...) Stroke Sequence, aform-emphasisstrategy, (2) Key-images, aform+meaningstrategy utilizing visual code, (3) Pithy Formulas with Key-images, aform+meaningstrategy combining visual and verbal codes. A pretest–posttest equivalent-group design was adopted. The independent variables were the learning strategy, the method of presenting character pairs (visually similar vs. dissimilar), and testing time. The dependent variables were learners’ proportions of accurate responses to reading and writing Chinese characters through a posttest (immediately performed after learning) and a delayed posttest (1 week after learning); a learner experience survey was also administered to investigate learners’ opinions on each strategy. Sixty-six non-beginning learners of Chinese participated; they were randomly assigned to one of the two groups in which participants learned ten charactersviathe three strategies, respectively, differing between whether the characters were presented in similar pairs or dissimilar pairs. Data were analyzedviathree-way ANCOVAs. The Pithy Formulas with Key-images and the Key-images generally yielded higher writing accuracy than Stroke Sequence immediately after learning. Notably, the advantage of the Pithy Formulas with Key-images (verbal and visual) over the Key-images (visual) on writing was specific to the participants that learned with visually similar pairs rather than those that learned with dissimilar pairs. All strategies were effective for reading, yet learners’ experience ratings favored the twoform+meaningstrategies over the strategy that focused primarily onform.Suggestions for future research and pedagogical implications on learning visually similar characters were offered. (shrink)

Previous studies have shown that individuals in collectivist cultures may be more corrupt than those in individualist cultures when they are interacting with outgroup members. The countries that are least corrupt, according to the Transparency International Corruption Perceptions Index, tend to have horizontal individualist cultures, with Singapore being a prominent counterexample. Can findings at the cultural level of analysis be replicated at the individual level of analysis? To answer this question the authors examined the relationship between deception and cultural orientation (...) in a Singaporean sample. The results indicate that, despite the fact that Singapore is very low in corruption on the Transparency International Corruption Perceptions Index, vertical collectivism was still able to account for the variance in deception. Theoretical and practical implications are discussed. (shrink)

Anxious major depressive disorder is a common subtype of major depressive disorder; however, its unique neural mechanism is not well-understood currently. Using multimodal MRI data, this study examined common and specific alterations of amygdala subregions between patients with and without anxiety. No alterations were observed in the gray matter volume or intra-region functional integration in either patient group. Compared with the controls, both patient groups showed decreased functional connectivity between the left superficial amygdala and the left putamen, and between the (...) right superficial amygdala and the bilateral anterior cingulate cortex and medial orbitofrontal cortex, while only patients with anxiety exhibited decreased activity in the bilateral laterobasal and superficial amygdala. Moreover, the decreased activity correlated negatively with the Hamilton depression scale scores in the patients with anxiety. These findings provided insights into the pathophysiologic processes of anxious major depressive disorder and may help to develop new and effective treatment programs. (shrink)

My response to Stephen C. Angle focuses on his question: “Can the People (_min_ 民) ever grow up?” I conclude that the people-centered approach developed in “What Did the Emperor Ever Say?” (Lee 2020 ) does not rule out the idea of commoners becoming politically mature. With its focus on textual evidence specifically addressing the commoners and with its attentiveness to their political agency in historical China, the approach has the potential to help scholars find room for a more progressive (...) theory in the Confucian tradition. In response to Manyul I m, I clarify the meaning of paternalistic gratitude, specifying it as a reciprocal obligation toward the nontransactional benevolence received from the emperor. I then critically examine Im’s nonreciprocal theory of existential obligation. I argue that the existential obligation, as defined by Im, presents no check on an abusive relationship and therefore cannot withstand the test of textual evidence. Upon reflection, I conclude that the theory of paternalistic gratitude remains a plausible understanding of Confucian political obligation. For one, it accurately reflects the Confucian reciprocal idea that the commoners’ political obligation is conditional upon the ruler’s noncontractual benevolence. For another, it contains the feature of endurance which, as Im reminds us, is an essence in the parent-child relation and its political application. (shrink)

Background: Moral distress occurs when nurses experience ethical dilemmas. Issues related to these dilemmas are addressed in some nursing education courses. Nurses’ reaction to dilemma such as moral distress is relatively less noticed. Objective: This study aimed to identify and describe the various types of perceptions of moral distress exhibited by nurses. Research design: This study applied Q methodology to explore the perspectives of nurses regarding moral distress. Data were collected in two stages. First, in-depth interviews were conducted to collect (...) nurses’ opinions. Sentences that best fit the concepts of moral distress were extracted for the construction of Q statements. Second, nurses subjectively ranked these Q statements so that the relevant severity of moral distress could be determined using Q sorts. The study participants were nurses at a regional teaching hospital in northeast Taiwan. A total of 60 participants were invited to rank 40 moral distress Q statements. Ethical considerations: The study protocol was approved by the institutional review board of National Yang-Ming University Hospital. Only the participants who signed an informed consent form participated in the study. The respondents’ right to withdraw from the study was respected. Findings: Five types of responses were identified regarding the nurses’ perspectives. These types were “conflict with personal values,” “excessive of workload,” “curbing of autonomy,” “constraint engendered by organizational norms,” and “self-expectation frustration.” Conclusion: The findings regarding nurses’ experiences of moral distress can be used to construct multifaceted policies and solutions and to incorporate ethical education in training programs. (shrink)

Sleep quality, personality, and cognitive load potentially increase second language writing (SLW) anxiety and subsequently affect SLW achievement. This study investigates the predictions of sleep quality, personality (social inhibition/ negative affectivity), and cognitive load (content/ computer) toward SLW anxiety and achievement in a computer-based test. Participants included 172 voluntary undergraduates majoring in English as foreign language. SLW anxiety in a computer-based test, sleep disturbance, personality and cognitive load was assessed with the SLW Anxiety Inventory, Pittsburg Sleep Quality Index, Type-D Personality, (...) and cognitive load questionnaires. A structural equation modeling approach was applied to examine the interdependence among the observed variables. An adequate-fit SLW anxiety model was built (X2 = 6.37,df = 6,p = 0.383,NFI = 0.97,CFI = 1.00,RMSEA = 0.02; R-squared multiple correlations: SLW anxiety in a computer-based test = 0.19, computer-based SLW achievement = 0.07). The structural model showed that sleep disturbance (+0.17), social inhibition personality (+0.31), and computer-induced cognitive load (+0.16) were significant predictors of SLW anxiety in a computer-based test. Subsequently, SLW anxiety in a computer-based test (−0.16) and computer-induced cognitive load (−0.16) were significant negative predictors of computer-based SLW achievement. (shrink)

As the aging population, including frail older people, continues to grow in Mainland China, quality of life and end-of-life care for frail older people has attracted much attention. Advance care planning is an effective way to improve end-of-life care for people with advanced diseases, and it is widely used in developed countries; however, it is a new concept in Mainland China. The effects of advance care planning and its acceptability in Mainland China are uncertain because of its culture-sensitive characteristics. The (...) objective of this article is to discuss the serious social issue of caring for frail older people and illustrate the possibility of implementing advance care planning in nursing homes in Mainland China through a review of relevant literature, which will focus on legislation, healthcare system engagement, public engagement, and cultural issues. Recommendations to promote and implement advance care planning include choosing nursing homes as a proper setting, establishing an ethical climate, and enhancing public awareness. (shrink)

Taiwan was affected by an outbreak of severe acute respiratory syndrome (SARS) in early 2003. A questionnaire survey was conducted to determine (1) the perceptions of risk of SARS infection in nurses; (2) the proportion of nurses considering leaving their job; and (3) work as well as non-work factors related to nurses' consideration of leaving their job because of the SARS outbreak. Nearly three quarters (71.9%) of the participants believed they were 'at great risk of exposure to SARS', 49.9% felt'an (...) increase in workload', and 32.4% thought that people avoided them because of their job; 7.6% of the nurses not only considered that they should not care for SARS patients but were looking for another job or considering resignation. The main predictors of nurses' consideration of leaving their job were shorter tenure, increased work stress, perceived risk of fatality from SARS, and affected social relationships. The findings are important in view of potential impending threats of pandemics such as avian influenza. (shrink)