Background Caring practice begins with awareness of the suffering of patients in a given context. Understanding the interrelationship between the perceived ethical climate of the clinical environment and the ethical sensitivity and caring efficacy of nurses is crucial for strengthening the caring competency of nurses. Research aim This study aimed to examine the associations between the ethical climate of the clinical environment and the ethical sensitivity and caring efficacy of nurses and to investigate the mediating effect of ethical sensitivity on (...) the association between ethical climate and caring efficacy. Research design This was a quantitative study with a cross-sectional descriptive correlational design. The participants completed an online survey that measured the ethical climate, ethical sensitivity and caring efficacy using the Hospital Ethical Climate Survey, Moral Sensitivity Questionnaire-Revised and Caring Efficacy Scale, respectively. Participants and research context The study recruited 293 nurses from two general hospitals that provided acute in-patient and extended care in Hong Kong. Ethical considerations Ethical approval was obtained from the ethics committee of the university and the hospitals involved. Written consent was obtained from the participants. Results Ethical climate was associated with caring efficacy ( β = 0.340, p <.001) and ethical sensitivity ( β = 0.197, p <.001). After adjusting for ethical climate, ethical sensitivity was associated with caring efficacy ( β = 0.860, p <.001). Ethical sensitivity showed a significant mediating effect on the association between ethical climate and caring efficacy (indirect effect = 0.169, 95% confidence interval: 0.097 to 0.261), which accounted for 50% of the total effect. Conclusions The study reveals the complex and interwoven relationship between contextual and personal factors that affect nurses’ caring efficacy from an ethical perspective. It provides insights into the significant roles of ethical climate and ethical sensitivity in strengthening caring efficacy. The results suggest theoretical and clinical implications for professionalisation. (shrink)

PurposeThis study aims to develop and validate a stigma scale for Chinese patients with breast cancer.MethodsPatients admitted to the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, for breast cancer treatment participated in this study. Development of the Breast Cancer Stigma Scale involved the following procedures: literature review, interview, and applying a theoretical model to generate items; the Breast Cancer Stigma Scale’s content validity was assessed by a Delphi study and feedback from patients with breast cancer ; (...) exploratory factor analysis was used to assess the construct validity; convergent validity was assessed with the Social Impact Scale ; internal consistency Cronbach’s α, split-half reliability, and test–retest reliability were used to identify the reliability of the scale.ResultsThe final version of the Breast Cancer Stigma Scale consisted of 15 items and showed positive correlations with the Social Impact Scale. Exploratory factor analysis revealed four components of the Breast Cancer Stigma Scale: self-image impairment, social isolation, discrimination, and internalized stigma, which were strongly related to our perceived breast cancer stigma model and accounted for 69.443% of the total variance. Cronbach’s α for the total scale was 0.86, and each subscale was 0.75–0.882. The test–retest reliability with intra-class correlation coefficients of the total scale was 0.947, and split-half reliability with intra-class correlation coefficients of the total scale was 0.911. The content validity index was 0.73–1.0.ConclusionThe newly developed Breast Cancer Stigma Scale offers a valid and reliable instrument for assessing the perceived stigma of patients with breast cancer in clinical and research settings. It may be helpful for stigma prevention in China. (shrink)

ObjectivesA sample of women with persistent distress following breast cancer previously exhibited attentional bias away from supraliminally presented cancer-or threat-related information, responses consistent with avoidance coping, and showed negative interpretation bias. Here, we attempt to characterize the nature of supraliminal AB and interpretation bias in that sample of women by comparing against healthy controls.MethodsExtending our previous work, we compared AB patterns for supraliminally presented negatively valenced words and cancer-related information assessed by modified dot-probe tasks and negative interpretation bias assessed by (...) an ambiguous cue task between 140 BC women previously identified as featuring low-stable or persistent high anxiety and 150 age-matched non-BC healthy controls having HADS-defined low or high anxiety.ResultsAttentional avoidance of non-cancer-related negatively valenced words was seen among the anxious BC group, while heightened attention toward such words was seen in anxious healthy controls, F = 3.97, p = 0.009. However, all anxious women in both BC and healthy groups directed attention away from CRI under supraliminal conditions. Interpretation bias scores were significantly higher in BC women with high anxiety vs. healthy controls with high anxiety, F = 13.26, p < 0.001.ConclusionWomen with high anxiety generalized conscious attentional avoidance responses to negatively valenced stimuli, indicating a likely hypersensitivity to potential threat in ambiguous cues and exaggerated threat perception. This may cause maladaptive emotional regulation. Attention focus training, reducing threat salience or modifying threat appraisal, may help women alleviate anxiety levels after BC. (shrink)

I was excited to know what they have to tell us, their pain and their agony, because they never speak of that in the classroom, they never tell us how they feel. They only come to learn … I was rea...

This book provides a new interpretation of Hegel's philosophy, arguing that his theory of reason and thinking revolve around the concept of organic life. Through a detailed analysis of Hegel's philosophy and Kant's influence, Karen Ng shows that Hegel's unique contribution is that cognitive capacities are indexed to species capacities, where embodiment and the relation to the environment are central in processes of mind.

Pessimism over a democracy’s ability to produce good outcomes is as longstanding as democracy itself. On one hand, democratic theorists consider democracy to be the only legitimate form of government on the basis that it alone promotes or safeguards intrinsic values like freedom, equality, and justice. On the other, skepticism toward the ordinary citizen’s cognitive capacities remains a perennial concern. Qualms about the epistemic value of democracy have only been made more pertinent by a fundamental problem of deep epistemic disagreement (...) which underlies the post-truth phenomenon. I argue that the democratic theorists who have sought to defend democracy on epistemic grounds have thus far neglected such deep and intractable disagreements. Without addressing this oversight, the epistemic democrat will find that collective decision-making processes quickly become paralyzed and will not be able to yield the epistemic benefits they promise. Hence, the work for epistemic democrats is to recognize and take into account the ramifications of epistemic disagreements so as to make a stronger case for epistemic democracy. (shrink)

In summary, the discussion by Professors Helmchen and Müller-Oerlinghausen of the morality of clinical trials has emphasized a point that is frequently overlooked. It is an essential to consider those situations in which it might be unethical not to conduct a trial as it is to be concerned about the ways in which trials might restrict the rights of the individuals taking part in them. They and I have dealt mainly with the first of these two issues because it has (...) been relatively neglected. The second is, of course, equally important and has rightly received much attention. Both matters deserve further public discussion. (shrink)

ObjectivesWorking-age cancer patients face barriers to resuming work after treatment completion. Those resuming work contend with reduced productivity arising from persisting residual symptoms. Existing studies of return to work after cancer diagnosis were done predominantly in Western countries. Given that employment and RTW in cancer survivors likely vary regionally due to healthcare provision and social security differences, we documented rates and correlates of RTW, work productivity, and activity impairment among Chinese cancer survivors in Hong Kong at one-year post-treatment.MethodsOf 1,106 cancer (...) patients assessed at six-months post-cancer treatment, 593 previously worked; detailed work status, psychological distress, physical symptom distress, supportive care needs, health-related quality of life, and illness perception were assessed. Six months later, work productivity and activity impairment were assessed. Descriptive analyses examined RTW rate. Fully adjusted regressions determined RTW, work productivity, and activity impairment predictors.ResultsAt baseline, 39% were working, 26% on sick leave, and 35% were unemployed. Compared to patients returning to work, unemployed participants were older, likely manual/service-oriented workers, and had lower family income, chemotherapy, fewer unmet health system and information needs, poorer physical functioning, and negative illness perceptions. Sick leave participants were likely service-oriented workers, who had head and neck cancer, chemotherapy, and poor physical functioning. At FU, baseline depressive symptoms, physical symptom distress, and negative illness perceptions predicted presenteeism and work productivity loss; gynecological cancer, fewer unmet health system and information needs, and greater unmet sexuality needs predicted absenteeism; physical symptom distress, negative illness perception, and poor physical functioning predicted activity impairment.ConclusionCancer survivors who had more physically demanding jobs and poorer physical functioning delayed RTW. Unmanaged physical symptom and psychological distress hindered work productivity. (shrink)

The Master from Mountains and Fields is a fully annotated translation of the prose texts from the "collected works" of Sŏ Kyŏngdŏk (1489-1546), an influential Confucian scholar from the early Chosŏn period (1392-1910). A native of Songdo (also known as Kaesŏng) in present-day North Korea, Sŏ has loomed large in the Korean cultural imagination and appeared as an exceptional sage and popular hero in numerous tales, dramas, and films, yet his writings are little known outside the academic milieu. Also called (...) Master Hwadam, Sŏ embodied an archetype of the secluded scholar who remains hidden in "mountains and forests" to devote himself to his studies. Held in esteem in both South and North Korea today (a notable exception in contemporary studies on Chosŏn Neo-Confucianism), Sŏ and his ideas about Vital Energy influenced the great Korean Neo-Confucian debates of the sixteenth and seventeenth centuries surrounding the psychophysiological origins of morality as well as various non-orthodox intellectual trends in the late Chosŏn. His thought is fundamentally rooted in the cosmology based on the exegesis of the Book of Changes and follows the teachings of various early Chinese Neo-Confucian thinkers; it presents a vivid example of the eclectic nature of ideas and intellectual trends coexisting within what is generically called Neo-Confucianism out of convenience. This volume presents the first English translation of all prose writings attributed to Sŏ and most of the peritexts from his posthumously published collection Hwadam chip. It reflects the importance of literary compilations (munjip) in the intellectual history of Chosŏn and the complex process of the making of Confucian masters in Korea. Sŏ's prose works are concise and diverse and offer a glimpse at an author who thwarts stereotyping; an introduction and annotations provide further context. The lengthy endnotes that accompany each text make this a useful handbook for anybody interested in Chosŏn Korea and Confucianism, from students in East Asian and Korean studies to specialists in literary Chinese (hanmun) or East Asian intellectual history. (shrink)