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)

The puzzle has played a significant role in Chinese culture since its formation. The Lo-shu and the Ba-gua, the most prominent number puzzle in ancient China, with its instinctual quest for universal order, has constructed a philosophical system that has incorporated human being as an integral part of nature. The system has exerted great influence on Chinese culture to this day. Because of its mysterious origin and magical evolution, the Ba-gua has been used to predict the fortune of both the (...) nation and the individual. The Chinese character-deconstructing puzzle has also functioned as a foreshadow of one’s fate. By analyzing the components of a character, written by the subject in a specific context, divination was made. In contrast to the solemn mission of the number puzzle, and the character-deconstructing puzzle, the wedding puzzle and the riddle are lighthearted, and intended to provoke humor, and to function pedagogically. A latecomer, once the mysteriousness of number and character has faded, the riddle is used to promote the intellectual development of children. The wedding puzzle has been popular among those who are illiterate and make analogy by using common occurrence to allude to taboo in the oral dialect. Since their illiteracy has excluded them from reading and writing, they are free to make puzzles in their own dialect without being limited by a reverence for the written character. (shrink)

A new method of multiattribute decision making is proposed based on the max-min and min-max gray association degree. The gray association coefficients between the alternative, positive ideal solution and negative ideal solution are defined. Here, we construct a bi-objective programming model that maximizes the minimum gray association degree and minimizes the maximum gray association degree simultaneously. By using the linear weighted summation method, the bi-objective programming model is transformed into a linear programming model. Thus, we can obtain the weight vector (...) of attributes by solving the linear programming model. The ranking order of alternatives is generated according to the relative closeness. A numerical example is examined to demonstrate the applicability and implementation process of the decision method proposed in this paper. (shrink)

Section One - Principles and concepts of healthcare law and ethics -- Section Two - Complaints, disciplinary proceedings and indemnity insurance -- Section Three - Confidentiality, disclosure and apologies -- Section Four - Alternative dispute resolution and relationship with colleagues -- Section Five - Liabilities beyond healthcare practices.

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)

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)

The novel coronavirus disease that emerged at the end of 2019 began threatening the health and lives of millions of people after a few weeks. However, social and economic problems derived from COVID-19 have changed the development of individuals and the whole country. This study examines the work conditions of Taiwanese versus mainland China employees, and evaluates the relationship between support mechanisms and subjective wellbeing from a social cognitive career theory perspective. In this study, a total of 623 Taiwanese questionnaires (...) and 513 mainland China questionnaires were collected to compare the two sample groups in terms of the development of employees’ subjective wellbeing. The results show that the Taiwanese sample had more significant development paths compared to mainland China employees in terms of prior knowledge, perceived organizational support, self-efficacy, employee employability, subjective wellbeing, and job performance. Finally, based on the conclusions, this study proposes some specific suggestions on theoretical mode for future studies. (shrink)

Virtual community websites are one of the applications that provide a platform for people with common interests to extend their social relations in social media. With the proliferation of food safety incidents in recent years, social media has often been a major channel for public engagement in risk communication because of its social networking and immediate interaction. To understand the users’ needs and satisfaction, this study proposed a model to develop and evaluate the antecedents of continuance intention toward food safety (...) information from social media. Based on the questionnaire collected from 289 Facebook users, this study assessed the integrated model of the expectation-confirmation theory and technology acceptance model with technology readiness as moderator. The results showed that the perceived ease-of-use, usefulness, and confirmation indirectly affected social media continuance usage intention through satisfaction; perceived ease-of-use, usefulness, and satisfaction were the direct determinants that affected the users’ social media continuance intention. Furthermore, positive technology readiness had significant effects on the relationship between the perceived ease-of-use, usefulness, confirmation, satisfaction, and continuance intention toward food safety information. This study contributes some important suggestions and managerial implications for food safety promotion providers, practitioners, and academics in the food industry, and social media environment. (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)

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)

In real life, listening to music may be associated with an eyes-closed or eyes-open state. The effect of eye state on listeners’ reaction to music has attracted some attention, but its influence on brain activity has not been fully investigated. The present study aimed to evaluate the electroencephalographic (EEG) markers for the emotional valence of music in different eye states. Thirty participants listened to musical excerpts with different emotional content in the eyes-closed and eyes-open states. The results showed that participants (...) rated the music as more pleasant or with more positive valence under an eyes-open state. In addition, we found that the alpha asymmetry indices calculated on the parietal and temporal sites reflected emotion valence in the eyes-closed and eyes-open states, respectively. The theta power in the frontal area significantly increased while listening to emotional-positive music compared to emotional-negative music under the eyes-closed condition. These effects of eye states on EEG markers are discussed in terms of brain mechanisms underlying attention and emotion. (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)

To understand the gaps between current bioethics education and the requirements of practicing nurses, a semistructured questionnaire was used to invite the directors of nursing departments at all 82 teaching hospitals in Taiwan to participate in this survey. The response rate was 64.6%. Through content analysis we obtained information about previous bioethical training, required themes and content, recommended teaching strategies, and difficulties with education and its application. The results suggest that Taiwanese nursing personnel need to be instilled with both self-cultivation (...) of morality and mental cultivation to acquire nursing virtues and the right attitudes toward bioethical issues. Good communication skills to prevent damage to the harmonious relationships between patients, their families and medical team members, policies that support the provision of systematic formal knowledge of ethics, small group training, and clarification of values were also shown to be important in bioethics education. (shrink)

We find that agency problems are embedded in firm's excess and abnormal equity investments that are mainly dictated by controlling shareholder's motives and ethical choices manifested in ownership and board structure. The excess equity investment is gauged with respect to industry average. The abnormal equity investment is specifically referred to the number of nominal investment companies that are fully controlled by the controlling owners while subject to little governance. Our empirical evidences of 345 Taiwanese non-financial listed firms show that firm's (...) excess and abnormal equity investments are negatively correlated with controlling shareholder's cash flow rights while are positively correlated with the control-cash flow deviation, and board affiliation. The results are supportive of the positive incentive hypothesis and the negative entrenchment hypothesis put forth by La Porta et al. and Claessen et al.. The negative relation between equity investment and firm's value further supports the agency postulation that corporate excess and abnormal equity investments represent a leeway for controlling shareholder to exploit wealth of minority shareholders. This study potentially contributes to the literature of business ethics by portraying an empirically testable linkage from controlling owner's ethical choices to his actions and therefore firm's value. (shrink)

PurposeThis study aims to describe the adverse events following immunization of SARS-CoV-2 vaccination in cancer patients/survivors associated with their psychological distress.MethodsA cross-sectional study was conducted to assess AEFIs after the receipt of SARS-CoV-2 vaccines in cancer patients/survivors attending a university hospital in Malaysia. Psychological distress was measured using the Hospital Anxiety and Depression Scale before and after the first and second doses of COVID-19 vaccine.ResultsA total of 217 complete responses were received. Compared with before vaccination, both HADS Anxiety and HADS (...) Depression scores were significantly reduced after the first and second dose of the SARS-CoV-2 vaccine. Most of the participants had mild-or-moderate systemic and local AEFIs, with the most common being pain at the injection site, tiredness, and headache for both the first and second doses of the vaccine. Positive correlations between the total AEFI score and HADS-A and HADS-D scores were observed after the first dose of the SARS-CoV-2 vaccine. Similarly, positive associations were observed between the total AEFI score and HADS-A and HADS-D scores after the second dose of the SARS-CoV-2 vaccine.ConclusionMild-to-moderate AEFIs found in this study help address vaccine hesitancy in cancer patients/survivors. Receiving the SARS-CoV-2 vaccine had a positive effect on decreasing psychological distress in cancer patients/survivors. High severity of an AEFI was associated with higher anxiety and depressive symptoms. (shrink)

Religion inspires honesty. The love of money incites dishonesty. Religious and monetary values apply to all religions. We develop a formative theoretical model of monetary wisdom, treat religiosity (God) and the love of money (mammon), as two yoked antecedents—competing moral issues (Time 1), and frame the latent construct in good barrels (performance or humane contexts, Time 2), which leads to (dis)honesty (Time 3). We explore the direct and indirect paths and the model across genders. Our three-wave panel data (411 participants) (...) show that religious and monetary values are negatively correlated. Directly, religiosity consistently curbs dishonesty; surprisingly, the love of money has no impact on dishonesty. In the performance context, the two mediation effects reduce dishonesty. Across genders, this mediation effect is nonsignificant for males but significantly excites females' honesty. In the humane context, the two mediation effects are nonsignificant. Across genders, for the love of money, males passively curb dishonesty by omission, and females actively engage in honesty by commission. Decision-makers must challenge people's moral issues, frame them in good barrels, and help people become good apples, choice architects, and moral and ethical decision-makers, promoting the Matthew effect in religion. We offer practical implications to individuals and organizations. (shrink)

Ruyu HungNational Chiayi UniversityThis collective writing is intended to portray the contour of philosophy of education in contemporary Taiwan, resounding many beautiful counterparts in EPAT (Bies...

Is the societal-level of analysis sufficient today to understand the values of those in the global workforce? Or are individual-level analyses more appropriate for assessing the influence of values on ethical behaviors across country workforces? Using multi-level analyses for a 48-society sample, we test the utility of both the societal-level and individual-level dimensions of collectivism and individualism values for predicting ethical behaviors of business professionals. Our values-based behavioral analysis indicates that values at the individual-level make a more significant contribution to (...) explaining variance in ethical behaviors than do values at the societal-level. Implicitly, our findings question the soundness of using societal-level values measures. Implications for international business research are discussed. (shrink)

Recent advances in mobile electroencephalogram (EEG) systems, featuring non-prep dry electrodes and wireless telemetry, have urged the needs of mobile brain-computer interfaces (BCIs) for applications in our daily life. Since the brain may behave differently while people are actively situated in ecologically-valid environments versus highly-controlled laboratory environments, it remains unclear how well the current laboratory-oriented BCI demonstrations can be translated into operational BCIs for users with naturalistic movements. Understanding inherent links between natural human behaviors and brain activities is the key (...) to ensuring the applicability and stability of mobile BCIs. This study aims to assess the quality of steady-state visual-evoked potentials (SSVEPs), which is one of promising channels for functioning BCI systems, recorded using a mobile EEG system under challenging recording conditions, e.g., walking. To systemati-cally explore the effects of walking locomotion on the SSVEPs, this study instructed subjects to stand or walk on a treadmill running at speeds of 1, 2, and 3 mile (s) per hour (MPH) while con-currently perceiving visual flickers (11 and 12 Hz). Empirical results of this study showed that the SSVEP amplitude tended to deteriorate when subjects switched from standing to walking. Such SSVEP suppression could be attributed to the walking locomotion, leading to distinctly deteriorated SSVEP detectability from standing (84.87±13.55%) to walking (1 MPH: 83.03±13.24%, 2 MPH: 79.47±13.53%, and 3 MPH: 75.26±17.89%). These findings not only demonstrated the applicability and limitations of SSVEPs recorded from freely behaving humans in realistic environments, but also provide useful methods and techniques for boosting the translation of the BCI technology from laboratory demonstrations to practical applications. (shrink)

In the presence of heterogeneity between the randomized controlled trial (RCT) participants and the target population, evaluating the treatment effect solely based on the RCT often leads to biased quantification of the real-world treatment effect. To address the problem of lack of generalizability for the treatment effect estimated by the RCT sample, we leverage observational studies with large samples that are representative of the target population. This article concerns evaluating treatment effects on survival outcomes for a target population and considers (...) a broad class of estimands that are functionals of treatment-specific survival functions, including differences in survival probability and restricted mean survival times. Motivated by two intuitive but distinct approaches, i.e., imputation based on survival outcome regression and weighting based on inverse probability of sampling, censoring, and treatment assignment, we propose a semiparametric estimator through the guidance of the efficient influence function. The proposed estimator is doubly robust in the sense that it is consistent for the target population estimands if either the survival model or the weighting model is correctly specified and is locally efficient when both are correct. In addition, as an alternative to parametric estimation, we employ the nonparametric method of sieves for flexible and robust estimation of the nuisance functions and show that the resulting estimator retains the root- n n consistency and efficiency, the so-called rate-double robustness. Simulation studies confirm the theoretical properties of the proposed estimator and show that it outperforms competitors. We apply the proposed method to estimate the effect of adjuvant chemotherapy on survival in patients with early-stage resected non-small cell lung cancer. (shrink)

Speech recognition by second language (L2) learners in optimal and suboptimal conditions has been examined extensively with English as the target language in most previous studies. This study extended existing experimental protocols ( Wang et al., 2013 ) to investigate Mandarin speech recognition by Japanese learners of Mandarin at two different levels (elementary vs. intermediate) of proficiency. The overall results showed that in addition to L2 proficiency, semantic context, F0 contours, and listening condition all affected the recognition performance on the (...) Mandarin sentences. However, the effects of semantic context and F0 contours on L2 speech recognition diverged to some extent. Specifically, there was significant modulation effect of listening condition on semantic context, indicating that L2 learners made use of semantic context less efficiently in the interfering background than in quiet. In contrast, no significant modulation effect of listening condition on F0 contours was found. Furthermore, there was significant interaction between semantic context and F0 contours, indicating that semantic context becomes more important for L2 speech recognition when F0 information is degraded. None of these effects were found to be modulated by L2 proficiency. The discrepancy in the effects of semantic context and F0 contours on L2 speech recognition in the interfering background might be related to differences in processing capacities required by the two types of information in adverse listening conditions. (shrink)

A surprisingly large number of lottery prizes go unclaimed every year. This leads us to suspect that what people bet on is not only money, but also good mood. We conducted three studies to explain, from an emotional perspective, why people play lottery games. We first conducted two survey studies to assess mood state reported by online (Study 1a) and offline lottery buyers (Study 1b) at different stages of lottery play. The results revealed that participants’ highest mood appeared before knowing (...) whether they had won. In Study 2, we manipulated the means of reward (lottery tickets vs. cash) and compared participants’ mood changes at different stages of a rewards game in the laboratory. We found the following: first, lottery group participants were generally in a better mood; second, 42% of lottery group participants did not come to the laboratory to collect scratch cards; and third, lottery group participants took more time to return to the laboratory to check their tickets than participants in the cash group. In Study 3, we examined whether priming good or bad mood could influence participants’ preferences for cash versus lottery tickets. The results revealed that participants who were primed for poor mood had a higher preference for lottery tickets compared with their good mood counterparts. These findings suggest that what our participants sought in lottery play was not only money, but improved mood. (shrink)

This article provides current Schwartz Values Survey (SVS) data from samples of business managers and professionals across 50 societies that are culturally and socioeconomically diverse. We report the society scores for SVS values dimensions for both individual- and societal-level analyses. At the individual-level, we report on the ten circumplex values sub-dimensions and two sets of values dimensions (collectivism and individualism; openness to change, conservation, self-enhancement, and self-transcendence). At the societal-level, we report on the values dimensions of embeddedness, hierarchy, mastery, affective (...) autonomy, intellectual autonomy, egalitarianism, and harmony. For each society, we report the Cronbach’s α statistics for each values dimension scale to assess their internal consistency (reliability) as well as report interrater agreement (IRA) analyses to assess the acceptability of using aggregated individual level values scores to represent country values. We also examined whether societal development level is related to systematic variation in the measurement and importance of values. Thus, the contributions of our evaluation of the SVS values dimensions are two-fold. First, we identify the SVS dimensions that have cross-culturally internally reliable structures and within-society agreement for business professionals. Second, we report the society cultural values scores developed from the twenty-first century data that can be used as macro-level predictors in multilevel and single-level international business research. (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)

Attending cram school has long been a trend in ethnic Chinese culture areas, including Taiwan. Despite the fact that school reform policies have been implemented in Taiwan, cram schools have continued to prosper. Therefore, in this educational culture, how to achieve a good educational effect is also a topic worthy of discussion. However, whether students really engage in those tutoring programs provided by cram schools has seldom been studied. To address this gap, this study explored how parents’ hovering attitude toward (...) life and coursework influences their children’s engagement in cram schools. This study targeted those students who attend English cram schools to test the correlates between two types of helicopter parenting, tutoring engagement and continued attendance at cram schools. A total of 320 questionnaires were sent out, and 300 were returned, giving an overall response rate of 93.75%. Excluding seven incomplete or invalid questionnaires, 293 valid questionnaires were received. The results of this study show that hovering behavior awareness is negatively related to cram school engagement, whereas cram school engagement is positively related to the intention to continue attending cram school. Moreover, the results imply that parents should alleviate their helicoptering behavior to enhance their children’s engagement in cram school tutoring programs. (shrink)

This essay explores the correlation between shu 恕 and ren 仁 in Confucius’ teachings and its broader implications concerning the role of the golden rule. It first shows that whereas the golden rule is premised on equality between agent and recipient, Confucius’ correlation of shu with ren aims mainly at establishing a more solid foundation for the hierarchy-specific duty of the ruler to care for the ruled. It thus reveals that this conflict arises from the golden rule’s incompatibility with asymmetrical (...) relationships, a long-standing issue concerning its validity as a moral axiom. It then addresses this conflict by demonstrating that the golden rule can effectively function in conformity with humanity even in asymmetrical relationships by way of inducing an agent’s viewpoint to shift from existing sociopolitical asymmetry to one-to-one human equality. On this basis, lastly, it examines the concurrence of the ideas of shu, human nature, and ren in ancient China. (shrink)

Huangdi Yin fu jing -- Tai bai yin jing -- Su shu --Tian shu -- Tong xun zhen jing.

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)