This paper gives an account of Kant’s concept of self-contentment (Selbstzufriedenheit), i.e. the satisfaction involved in the performance of moral action. This concept is vulnerable to an important objection: if moral action is satisfying, it might only ever be performed for the sake of this satisfaction. I explain Kant’s response to this objection and argue that it is superior to Francis Hutcheson’s response to a similar objection. I conclude by showing that two other notions of (...) class='Hi'>moral satisfaction in Kant’s moral philosophy, namely ‘sweet merit’ and the highest good, also avoid the objection. (shrink)

The studies show a positive and direct relationship between basic psychological needs satisfaction and intrinsic motivation of the students. However, there is a lack of studies that analyze the psychological processes that affect these relationships. For this reason, the purpose of this study was to investigate the mediating role of academic integration on the relationship between basic psychological needs satisfaction and intrinsic motivation of Chilean university students. The participants were a total of 580 students from a university in (...) northern Chile, 359 women and 221 men. The mediation analysis was performed by structural equations modeling, using the maximum likelihood method and the bootstrapping procedure with 10,000 iterations. The results indicated that academic integration partially mediated the relationship between basic psychological needs satisfaction and intrinsic motivation of the students. Therefore, the basic psychological needs satisfaction had an indirect effect on the intrinsic motivation of the students through academic integration. It is concluded that the academic integration constitutes a psychological process that promotes the development of intrinsic motivation for learning. The practical implications are discussed along with the limitations of the study and recommendations for future research. (shrink)

Positive Psychology has turned its attention to the study of emotions in a scientific and rigorous way. Particularly, to how emotions influence people’s health, performance, or their overall life satisfaction. Within this trend, Flow theory has established a theoretical framework that helps to promote the Flow experience. Flow state, or optimal experience, is a mental state of high concentration and enjoyment that, due to its characteristics, has been considered desirable for the development of the performing activity of performing musicians. (...) Musicians are a population prone to health problems, both psychological and physical, owing to different stressors of their training and professional activity. One of the most common problems is Musical Performance Anxiety. In this investigation, an electronic intervention program was carried out for the development of psychological self-regulation skills whose main objective was to trigger the Flow response in performing musicians and the coping mechanism for Musical Performance Anxiety. A quasi-experimental design was used with a control group in which pre- and post-measures of Flow State, Musical Performance Anxiety and, also, Social Skills were taken. Sixty-two performing musicians from different music colleges in Spain participated in the program. Results indicated that the intervention significantly improved Flow State, and Sense of Control, and decreased Music Performance Anxiety, and self-consciousness of the participants in the EG but not CG. The changes in the EG after the program showed the inverse relationship between Flow and Anxiety. Two important theoretical factors of both variables, such as worry and the feeling of lack of control, could be involved. The results are under discussion and future lines of research are proposed. (shrink)

May's careful examination of empirical evidence makes a compelling case against the primacy of emotion in driving moral judgments. At the same time, emotion certainly is involved in moral judgments. We argue that emotion interacts with beliefs, values, and moral principles through a process of coherence-based reasoning (operating at least partially below the level of conscious awareness) in generating moral judgments and decisions.

Background: Since moral distress affects psychological aspects of psychiatric nurses, it is an important theme. Previous studies showed relationships between moral distress and job satisfaction; however, there are few studies which investigate relationships between moral distress and other effective variables and then we highlighted relationships among these variables. Objective: This study aimed to (1) examine relationships among moral distress, sense of coherence, mental health, and job satisfaction and (2) clarify the most predictive variable to (...) job satisfaction. Research design: This study is a cross-sectional study. Participants were 130 psychiatric nurses in a hospital in Japan. They completed the Moral Distress Scale for Psychiatric nurses (Unethical conduct, Low staffing, and Acquiescence to patients’ rights violations), the sense of coherence scale (Comprehensibility, Manageability, and Meaning), the General Health Questionnaire, and the Job Satisfaction scale. Ethical consideration: This study was approved by the ethical board of St Mary’s College. Nurses participated voluntarily and were anonymous. Results: Results showed that subscales of the Moral Distress Scale for Psychiatric nurses negatively correlated to the sense of coherence and the Job Satisfaction. A multiple regression analysis showed that “Acquiescence to patients’ rights violations” of the Moral Distress Scale for Psychiatric nurses and “Meaning” of the sense of coherence influenced the Job Satisfaction much more than other variables. These two variables were correlated to job satisfaction scale, and other variables without them did not significantly correlate to job satisfaction scale. Discussion: These results suggest that moral distress negatively related to sense of coherence and job satisfaction, a subscale of the Moral Distress Scale for Psychiatric nurses and that of the sense of coherence affected the job satisfaction the most. Conclusion: Decreasing of acquiescence to patients’ rights violations and finding meaning in nursing may improve job satisfaction. (shrink)

Moral stress is an increasingly significant concept in business ethics and the workplace environment. This study compares the impact of moral stress with other job stressors on three important employee variables—fatigue, job satisfaction, and turnover intentions—by utilizing survey data from 305 customer-contact employees of a financial institution’s call center. Statistical analysis on the interaction of moral stress and the three employee variables was performed while controlling for other types of job stress as well as demographic variables. (...) The results reveal that even after including the control variables in the statistical models, moral stress remains a statistically significant predictor of increased employee fatigue, decreased job satisfaction, and increased turnover intentions. Implications for future research and for organizations are discussed. (shrink)

The recent accounting scandals have raised concerns regarding the closeness of auditor–client relationships. Critics argue that as the relationship lengthens a bond develops and auditors’ professional skepticism may be replaced with trust. However, Statement on Auditing Standards No. 99 states that auditors “should conduct the engagement with a mindset that recognizes the possibility that a material misstatement due to fraud could be present, regardless of any past experience with the entity and regardless of the auditor’s belief about management’s honesty and (...) integrity” (AICPA 2002, Statement on Auditing Standards No. 99, paragraph 13, p. 10). The purpose of this study is to investigate whether auditors develop trust in a client’s management and whether this trust affects auditors’ decisions. Specifically, this study examines whether auditors’ satisfaction with a client’s management during a prior audit engagement affects auditors’ self-reported trust in that client’s management and whether that trust affects their fraud risk assessment. The decision to trust a client’s management should be an ethical decision because excessive trust may impair auditors’ skepticism, which auditors are required to maintain by their professional responsibilities. We therefore also investigate whether auditors’ trust is affected by their moral reasoning. An experimental case was completed by 89 professional auditors, all with experience assessing the risk of fraud. The results suggest auditors’ satisfaction with the client affects their trust in the client (higher satisfaction associated with higher trust and lower satisfaction associated with lower trust). Further, after an overall unsatisfying experience, auditors’ trust affects their fraud risk assessments. However, after an overall satisfying experience, their trust does not affect their fraud risk assessments. The results indicate auditors are able to maintain their professional skepticism after satisfying past experiences with the client regardless of their beliefs about the honesty and trustworthiness of the client’s management. Lastly, auditors’ moral reasoning was not related to their trust in the client’s management. (shrink)

This book examines some of the main problems involved in defining morality. Smith concedes that he cannot provide a fully satisfactory definition, but he believes that he can provide both a partial delimitation of the concept and a refutation of several related popular definitions. Since morality has a variety of meanings in ordinary usage, Smith offers a stipulative definition based on characteristics that he believes to be conceptually the most central. He states, "My focus will not be wholly arbitrary; I (...) will be guided partially by usage in the social sciences and partially by usage that is quite prevalent in good ordinary discourse." The stipulative definition that Smith offers in the first half of his book is of little value, however, because it places almost every code of conduct, including personal ethical egoism, within the sphere of morality. In the second half of the book, Smith attacks the view that reference to social harmony or welfare is necessary in any adequate definition of morality. After tracing the main reasons why morality is so often considered a device for promoting social welfare, Smith distinguishes several variants of the social welfare definition and presents a battery of clearly stated arguments against each. Even though Smith has provided only a partial analysis of the concept of morality, his clarification of the issues involved in formulating a satisfactory definition and his attack on the contention that morality is necessarily concerned with the welfare of others are useful.—M.G. (shrink)

The recent accounting scandals have raised concerns regarding the closeness of auditor–client relationships. Critics argue that as the relationship lengthens a bond develops and auditors' professional skepticism may be replaced with trust. However, Statement on Auditing Standards No. 99 states that auditors "should conduct the engagement with a mindset that recognizes the possibility that a material misstatement due to fraud could be present, regardless of any past experience with the entity and regardless of the auditor's belief about management's honesty and (...) integrity" (AICPA 2002, Statement on Auditing Standards No. 99, paragraph 13, p. 10). The purpose of this study is to investigate whether auditors develop trust in a client's management and whether this trust affects auditors' decisions. Specifically, this study examines whether auditors' satisfaction with a client's management during a prior audit engagement affects auditors' self-reported trust in that client's management and whether that trust affects their fraud risk assessment. The decision to trust a client's management should be an ethical decision because excessive trust may impair auditors' skepticism, which auditors are required to maintain by their professional responsibilities. We therefore also investigate whether auditors' trust is affected by their moral reasoning. An experimental case was completed by 89 professional auditors, all with experience assessing the risk of fraud. The results suggest auditors' satisfaction with the client affects their trust in the client (higher satisfaction associated with higher trust and lower satisfaction associated with lower trust). Further, after an overall unsatisfying experience, auditors' trust affects their fraud risk assessments. However, after an overall satisfying experience, their trust does not affect their fraud risk assessments. The results indicate auditors are able to maintain their professional skepticism after satisfying past experiences with the client regardless of their beliefs about the honesty and trustworthiness of the client's management. Lastly, auditors' moral reasoning was not related to their trust in the client's management. (shrink)

RESUMEN Introducción: El proceso de cuidar es el resultado de una construcción propia de cada situación, se origina con la identificación de los problemas de salud y las necesidades reales o potenciales de las personas, familia y comunidad que demandan cuidado. Objetivo: Evaluar el impacto del Diplomado Prevención del Síndrome de Burnout, en el autocuidado del personal de enfermería de la Atención Secundaria de Salud de la provincia Camagüey. Métodos: Se realizó un estudio descriptivo observacional, en el Hospital Amalia Simoni (...) Argilagos de Camagüey, durante el Diplomado Prevención del Síndrome de Burnout dirigido al personal de enfermería de la Atención Secundaria de Salud. Para ello se aplicó una encuesta y el Test Psicológico de Maslach y Jackson al inicio y al final de la aplicación del Diplomado. Los datos aportados por estos instrumentos se complementaron con los provenientes de la aplicación de la técnica del PNI. Resultados: Predominó el sexo femenino. El total de los cursistas son licenciados en Enfermería. Con la ejecución del diplomado se constatan cambios importantes en cuanto a la autopreparación, el rendimiento, los hábitos de descanso, satisfacción personal y realización de ejercicios físicos. Discusión: La aplicación del diplomado logró transformar estilos de trabajo, afrontamientos al estrés, así como una mejor satisfacción personal y colectiva. ABSTRACT Introduction: The process of taking care is the result of a proper construction of every situation, it originates with the identification of the problems of health and the real or potential needs of the persons, family and community that demand care. Objective: To evaluate the impact of Postgraduate Course Prevention of the Syndrome of Burnout, in the self-care of the personnel of infirmary of the Secondary Attention of Health of the Camagüey province. Methods: a descriptive, observational study was carried out in the Hospital Amalia Simoni Argilagos of Camagüey, during Postgraduate Course Prevention of the Syndrome of Burnout directed to the personnel of infirmary of the Secondary Attention of Health. For that reason, a survey and the Psychological Test of Maslach and Jackson was applied at the beginning and at the end of the application of the course. The information contributed by these instruments complemented itself with the originated ones from the application of the technique of the PNI. Results: The sex that predominated was the feminine one. All of the students are licensed in Infirmary. With the execution of the course important changes are stated as for the self-preparation, the yield, the habits of rest, personal satisfaction and achievement of physical exercises. Discussion: The application of the course managed to transform styles of work, confrontations to the stress, as well as a better personal and collective satisfaction. (shrink)

The performance appraisal process is increasingly seen as a key link between employee behaviour and an organization’s strategic objectives. Unfortunately, performance reviews often fail to change how people work, and dissatisfaction with the appraisal process has been associated with general job dissatisfaction, lower organizational commitment, and increased intentions to quit. Recent research has identified a number of factors related to reactions to performance appraisals in general and appraisal satisfaction in particular. Beyond the appraisal outcome itself, researchers have found that (...) appraisal reactions are affected by perceptions of fairness and the relationship between the supervisor and the employee. To explain the relationships among these factors, the present article proposes a moral cognition perspective. We suggest that employees judge a performance appraisal from the perspective of its moral justifiability, and that appraisal reactions will be determined, at least in part, by the perceived moral justifiability of the process. The proposal was supported by results from a survey of government employees using measures of performance ratings, leader–member exchange, perceived utility, and organizational justice. (shrink)

This work addresses itself to the question: How is morality to be properly defined?

The American Journal of Bioethics, Volume 12, Issue 5, Page 20-22, May 2012.

Moral distress has been widely reviewed across many care contexts and among a range of disciplines. Interest in this area has produced a plethora of studies, commentary and critique. An overview of the literature around moral distress reveals a commonality about factors contributing to moral distress, the attendant outcomes of this distress and a core set of interventions recommended to address these. Interventions at both personal and organizational levels have been proposed. The relevance of this overview resides (...) in the implications moral distress has on the nurse and the nursing workforce: particularly in regard to quality of care, diminished workplace satisfaction and physical health of staff and increased problems with staff retention. (shrink)

Background The birth plan is a tool that allows the self-learning and thoughtful analysis of the women during the birthing process, facilitating their making of decisions and participation, in agreement with the bioethical principles of autonomy and no malfeasance. Goal: To understand the perception and satisfaction of women who presented a birth plan. Methodology: Qualitative, descriptive, observational, retrospective and cross-sectional study. The population of the study was composed of 21 women who presented a birth plan regulated in a Hospital (...) ever since the recording of the presentation of the birth plan was started (2011) until 2015. Place: Cartagena (Murcia, Spain). Techniques/methods: Semistructured interview. Results-Discussion: Most women considered the plan as a useful self-learning tool on the meaning of the birthing process, as it favored the communication between the expectant mothers/health professionals. Our informants sought information related to the birthing process from informal sources; most perceived a level of respect of their wishes during the process of giving birth. The use of the birth plan did not imply the perception of loss of the degree of control during the birth, although attention to the written document could be improved. Conclusions The use of the birth plan is a very satisfactory and useful experience for their involvement in their self-care, although in some cases, the births did not proceed according to their plans. Nevertheless, the prevalence of the principle of Non-Malfeasance over Autonomy was evidenced. (shrink)

Welfare is at least occasionally a temporal phenomenon: welfare benefits befall me at certain times. But this fact seems to present a problem for a desire-satisfaction view. Assume that I desire, at 10am, January 12th, 2010, to climb Mount Everest sometime during 2012. Also assume, however, that during 2011, my desires undergo a shift: I no longer desire to climb Mount Everest during 2012. In fact, I develop an aversion to so doing. Imagine, however, that despite my aversion, I (...) am forced to climb Mount Everest. Does climbing Mount Everest benefit me? If so, when? A natural answer seems to be that if in fact it does benefit me, it benefits me at no particular time, and hence the desire-satisfaction view cannot accommodate the phenomenon of temporal welfare. In this paper, I argue, first, that a desire-satisfaction view can accommodate the phenomenon of temporal welfare only by accepting what I call the “time-of-desire” view: that p benefits x at t only if x desires p at t . Second, I argue that this view can be defended from important objections. (shrink)

Research has shown that corporate social responsibility (CSR) can have a positive impact on the firm’s reputation and financial performance. Moreover, CSR activities can have a positive impact on employees’ workplace experience. Consistent with past research, we argue that perceived organizational CSR value can have a positive impact on job satisfaction. We also argue that employees’ moral identity can play an important moderating role on the perceived CSR effect. Specifically, the current study was designed to test the predictive (...) effects of perceived organizational CSR value on job satisfaction. In addition, the study was designed to test the moderating roles of two moral identity dimensions, internalized and symbolic moral identity, on the effect of perceived organizational CSR value on job satisfaction. The study results were generally supportive of the hypotheses. Managerial implications of the study findings were also discussed. (shrink)

Background: Nurses are expected to provide comprehensive, holistic and ethically accepted care according to their code of ethics and practice. However, in Malawi, this is not always the case. This article analyses moral competence concept using the Walker and Avant's strategy of concept analysis. Objective: The aim of this article is to analyse moral competence concept in relation to nursing practice and determine defining attributes, antecedents and consequences of moral competence in nursing practice. Method: Analysis of (...) class='Hi'>moral competence concept was done using Walker and Avant's strategy of concept analysis. Results: Deductive analysis was used to find the defining attributes of moral competence, which were kindness, compassion, caring, critical thinking, ethical decision making ability, problem solving, responsibility, discipline, accountability, communication, solidarity, honesty, and respect for human values, dignity and rights. The identified antecedents were personal, cultural and religious values; nursing ethics training, environment and guidance. The consequences of moral competence are team work spirit, effective communication, improved performance and positive attitudes in providing nursing care. Conclusion: Moral competence can therefore be used as a tool to improve care in nursing practice to meet patients' problems and needs and consequently increase public's satisfaction in Malawi. (shrink)

This article offers a new theory about how using lotteries to distribute scarce benefits satisfies beneficiaries' claims. In the first section of the article I criticize John Broome's view and on the basis of these criticisms set out four desiderata for a philosophically adequate account of claim satisfaction by lottery. In section II I propose and defend a new view called the dual structure view, so called because it posits that claimants have two types of claims in the relevant (...) scarce benefit distribution cases under discussion. This view meets all the desiderata set out in section I. Section III draws out the practical implications of my view for a variety of temporally extended cases, including the distribution of corneas to patients who have suffered corneal degeneration. (shrink)

This dissertation investigates a number of ways in which an eighteenth century British philosophical movement known as “moral sense theory” influenced the development of German philosopher Immanuel Kant’s (1724-1804) moral theory. I illustrate that Kant found both moral sense theory’s conception of moral judgement and its conception of moral motivation appealing during the earliest stage of his philosophical development, but eventually came to reject its conception of moral judgement, though even in his early writings (...) Kant preserves certain features of its conception of moral motivation. In the mature presentation of his moral philosophy Kant offers detailed objections to moral sense theory’s conception of moral judgement, but I illustrate that, in opposition to the claims of many recent interpreters, his considered understanding of moral motivation has only a few superficial features in common with the view presented by Hutcheson in particular. Important for an understanding of Kant’s mature conception of motivation is also the thought of Adam Smith (1723-1790), a thinker who is not part of but was highly influenced by moral sense theory. I illustrate that Smith’s notion of the attitude of “regard” for what he calls the “general rules of conduct,” as well as his conception of the “sense of duty,” influenced Kant’s conception of “respect [Achtung]” for the moral law. Finally, I illustrate that Kant’s understanding of the pleasure associated with acting morally, what he calls “self-contentment [Selbstzufriedenheit],” can be clarified in light of how Hutcheson solves a problem related to the pleasure of the moral sense. (shrink)

Background: Providing oncological care to children is demanding and ethical issues concerning what is best for the child can contribute to moral distress. Objectives: To explore healthcare professionals’ experiences of situations that generate moral distress in Swedish paediatric oncology. Research design: In this national study, data collection was conducted using the Swedish Moral Distress Scale-Revised. The data analysis included descriptive statistics and non-parametric analysis of differences between groups. Participants and research context: Healthcare professionals at all paediatric oncology (...) centres in Sweden were invited to participate. A total of 278 healthcare professionals participated. The response rate was 89%. Ethical considerations: In its advisory statement, the Regional Ethical Review Board decided that the study was of such a nature that the legislation concerning ethical reviews was not applicable. All participants received written information about the aim of the study and confidentiality. Participants demonstrated their consent by returning the survey. Findings: The two situations with the highest moral distress scores concerned lack of competence and continuity of personnel. All professional groups reported high levels of disturbance. Nurses rated significantly higher frequencies and higher total Moral Distress Scale scores compared to medical doctors and nursing assistants. Discussion: Lack of competence and continuity, as the two most morally distressing situations, confirms the findings of studies from other countries, where inadequate staffing was reported as being among the top five morally distressing situations. The levels of total Moral Distress Scale scores were more similar to those reported in intensive care units than in other paediatric care settings. Conclusion: The two most morally distressing situations, lack of competence and continuity, are both organisational in nature. Thus, clinical ethics support services need to be combined with organisational improvements in order to reduce moral distress, thereby maintaining job satisfaction, preventing a high turnover of staff and ensuring the quality of care. (shrink)

This book provides a novel formulation and defence of moral error theory. It also provides a novel solution to the so-called now what question; viz., the question what we should do with our moral thought and talk after moral error theory. The novel formulation of moral error theory uses pragmatic presupposition rather than conceptual entailment to argue that moral judgments carry a non-negotiable commitment to categorical moral reasons. The new answer to the now what (...) question is pragmatic presupposition substitutionism: we should substitute our current moral judgments, which pragmatically presuppose the existence of categorical moral reasons with ‘schmoral’ judgments that pragmatically presuppose the existence of a specific class of prudential reasons. These are prudential reasons that, when we act on them, contribute to the satisfaction of what the author calls ‘the fundamental desire’; namely, the desire to live in a world with mutually beneficial cooperation. (shrink)

Background Moral distress is a common challenge among professional nurses when caring for their patients, especially when they need to make rapid decisions. Therefore, leaving moral distress unconsidered may jeopardize patient quality of care, safety, and satisfaction. Aim To estimate moral distress among nurses. Methods This systematic review and meta-analysis conducted systematic search in Scopus, PubMed, ProQuest, ISI Web of Knowledge, and PsycInfo up to end of February 2022. Methodological quality of included studies was assessed using (...) the Newcastle Ottawa checklist. Data from included studies were pooled by meta-analysis with random effect model in STATA software version 14. The selected key measure was mean score of moral distress total score with its’ 95% Confidence Interval was reported. Subgroup analyses and meta-regressions were conducted to identify possible sources of heterogeneity and potentially influencing variables on moral distress. Funnel plots and Begg’s Tests were used to assess publication bias. The Jackknife method was used for sensitivity analysis. Ethical consideration The protocol of this project was registered in the PROSPERO database under decree code of CRD42021267773. Results Eighty-six manuscripts with 19,537 participants from 21 countries were included. The pooled estimated mean score of moral distress was 2.55 on a 0–10 scale [95% Confidence Interval: 2.27–2.84, I2: 98.4%, Tau2:0.94]. Publication bias and small study effect was ruled out. Moral distress significantly decreased in the COVID-19 pandemic versus before. Nurses working in developing countries experienced higher level of moral distress compared to their counterparts in developed countries. Nurses' workplace (e.g., hospital ward) was not linked to severity of moral disturbance. Conclusion The results of the study showed a low level of pooled estimated score for moral distress. Although the score of moral distress was not high, nurses working in developing countries reported higher levels of moral distress than those working in developed countries. Therefore, it is necessary that future studies focus on creating a supportive environment in hospitals and medical centers for nurses to reduce moral distress and improve healthcare. (shrink)

Background: Rising levels of burnout and decreasing job satisfaction can inhibit healthcare professionals from providing high-quality care due to a corresponding decrease in their ethical sensitivity. Aim: This study aimed to determine the relationship between the level of ethical sensitivity in emergency service nurses and their levels of burnout and job satisfaction. Research design: This research employed a descriptive and cross-sectional design. Participants and research context: This study was conducted with a sample of 236 nurses, all of whom (...) worked in emergency service between 24 July 2015 and 28 April 2016. Data were collected using the Moral Sensitivity Questionnaire, Maslach Burnout Inventory, and Minnesota Job Satisfaction Scale. Ethical considerations: This study was approved by the Institutional Ethics Review Board of Ondokuz Mayıs University. Findings: There was a weak and negative correlation (r = –0.158, p = 0.015) between Moral Sensitivity Questionnaire and Maslach Burnout Inventory scores. There was also a weak and negative correlation (r = –0.335, p < 0.001) between the Maslach Burnout Inventory and Minnesota Job Satisfaction Scale scores. Discussion and conclusion: Decreased job satisfaction and increased burnout levels among emergency service nurses might result in them indulging in improper practices, frequently facing ethical problems, and a decrease in the overall quality of service in hospitals. In order for emergency service nurses to recognize ethical problems and make the most accurate decisions, a high level of ethical sensitivity is critical. In this respect, it is suggested that continuing education after graduation and training programs should be organized. (shrink)

This research examines how the fit between employees moral development and the ethical work climate of their organization affects employee attitudes. Person-organization fit was assessed by matching individuals' level of cognitive moral development with the ethical climate of their organization. The influence of P-O fit on employee attitudes was assessed using a sample of 304 individuals from 73 organizations. In general, the findings support our predictions that fit between personal and organizational ethics is related to higher levels of (...) commitment and job satisfaction and lower levels of turnover intent. Ethical P-O fit was related to higher levels of affective commitment across all three ethical climate types. Job satisfaction was only associated with ethical P-O fit for one of the three P-O fit variables and turnover intentions were significantly associated with two of the ethical P-O fit variables. The most consistent effect was found for the Conventional - Caring fit variable, which was significantly related to all three attitudes assessed. The weakest effect was found for the Preconventional - Instrumental fit variable, which was only predictive of affective commitment. The pattern of findings and implications for practice and future research are discussed. (shrink)

Moral distress in health care has been identified as a growing concern and a focus of research in nursing and health care for almost three decades. Researchers and theorists have argued that moral distress has both short and long-term consequences. Moral distress has implications for satisfaction, recruitment and retention of health care providers and implications for the delivery of safe and competent quality patient care. In over a decade of research on ethical practice, registered nurses and (...) other health care practitioners have repeatedly identified moral distress as a concern and called for action. However, research and action on moral distress has been constrained by lack of conceptual clarity and theoretical confusion as to the meaning and underpinnings of moral distress. To further examine these issues and foster action on moral distress, three members of the University of Victoria/University of British Columbia (UVIC/UVIC) nursing ethics research team initiated the development and delivery of a multi-faceted and interdisciplinary symposium on Moral Distress with international experts, researchers, and practitioners. The goal of the symposium was to develop an agenda for action on moral distress in health care. We sought to develop a plan of action that would encompass recommendations for education, practice, research and policy. The papers in this special issue of HEC Forum arose from that symposium. In this first paper, we provide an introduction to moral distress; make explicit some of the challenges associated with theoretical and conceptual constructions of moral distress; and discuss the barriers to the development of research, education, and policy that could, if addressed, foster action on moral distress in health care practice. The following three papers were written by key international experts on moral distress, who explore in-depth the issues in three arenas: education, practice, research. In the fifth and last paper in the series, we highlight key insights from the symposium and the papers in the series, propose to redefine moral distress, and outline directions for an agenda for action on moral distress in health care. (shrink)

Nurses may, and often do, experience moral distress in their careers. This is related to the complicated work environment and the complex nature of ethical situations in everyday nursing practice. The outcomes of moral distress may include psychological and physical symptoms, reduced job satisfaction and even inadequate or inappropriate nursing care. Moral distress can also impact retention of nurses. Although research has grown considerably over the past few decades, there is still a great deal about this (...) topic that we do not know including how to deal well with moral distress. A critical key step is to develop a deeper understanding of relational practice as it pertains to moral distress. In this article, exploration of the experience of moral distress among nurses is guided by the key elements of relational ethics. This ethical approach was chosen because it recognizes that ethical practice is situated in relationships and it acknowledges the importance of the broader environment on influencing ethical action. The findings from this theoretical exploration will provide a theoretical foundation upon which to advance our knowledge about moral distress. (shrink)

Rooting, defined as a spectator’s demonstrative encouragement of a contestant’s effort, ideally has the morally positive aspects of benevolent concern and helpfulness but in practice strains against reasonable standards of conduct by being rude, excessively biased, exploitative, fanatical, and superstitious. Rooting may activate an atavistic, morally cogent sense of fighting for one’s group that is at odds with the universalism of civilized morality. The ‘merely play’ excuse can cut both ways, deflecting moral objections but also removing moral credit (...) from rooting. Although rooting is often not humane, humane rooting can occur and is supported by humane commentary by sports participants, broadcasters, and journalists. Humane rooting supports the premise of benevolence theories (Mengzi, Hutcheson) that morally ideal benevolence has a foothold in an innate general benevolence – seen in this area especially in benevolence toward efforts. Being partisan, excited, and demonstrative, rooters cannot perfectly embody ‘universal calm benevolence’, but they can consciously minimize the inhumane aspects of rooting and achieve a more fully prosocial satisfaction. (shrink)

In the preface to the second edition of the Critique of Pure Reason Kant explicitly states that his motivation for writing this work is to make room for faith or the practical employment of reason . How does Kant accomplish this? The topics of God and the immortality of the soul do not arise until the conclusion of the antinomies. How does Kant get from the desire to make room for faith to its fulfilment in the latter parts of the (...) first Critique? A common response to this question is a discussion of the constitutive and regulative employment of the ideas of reason. It is this distinction that sustains Kant's attempt at reconciling empirical knowledge and moral discourse. The constitutive and regulative analysis, however, has its roots deep within the initial stages of the Critique of Pure Reason. It is, in fact, the mathematical/dynamical distinction, which Kant introduces early in the analytic, that makes possible the constitutive/regulative distinction. Not only has the mathematical/ dynamical distinction itself been disregarded, but the relation between the mathematical/dynamical and the constitutive/ regulative has been almost universally ignored by commentators. If a commentator does mention the mathematical/dynamical distinction, it is usually in a dismissive tone. Walsh, for example, calls the distinction ‘hard to interpret’ and ignores it for the rest of his commentary. (shrink)

Can events that take place after an individual’s death affect that person’s weIl-being? Aristotle apparently thought that they could, but Mark Overvold disagrees. Like other contemporary moral theorists, Overvold analyzes the notion of a person’s utility or welfare in terms of the fulfillment of the individual’s desires, but he adds the important qualification that the desites must be for states-of-affairs in which the agent is an essential constituent. The clear implication of such a view is that our welfare cannot (...) be affected by the post-mortem satisfaction of any of the interests which we had while alive.I shall defend Overvold against his critics who insist that at least some posthumous satisfactions can contribute to a person’s welfare. I shall also argue against Brad Hooker’s proposal that we revise Overvold’s theory in order to account for such cases. (shrink)

This empirical study investigates the effects of nine ethical climate types (self-interest, company profit, efficiency, friendship, team interest, social responsibility, personal morality, company rules and procedures, and lastly laws and professional codes) on employee work satisfaction. The ethical climate typology developed by Victor and Cullen (in W. C. Frederick (ed.) Research in Corporate Social Performance and Policy, 1987; Administrative Science Quarterly 33, 101–125, 1988) is tested on a sample of staff and managers from 62 different telecommunication firms in Turkey. (...) The results obtained from the 1174 usable questionnaires confirm the existence of nine different ethical climate types observed in western cultures in the present sample context, which is a developing Muslim country. Regarding the effects of ethical climatic factors on employee work satisfaction, self-interest climate type appears to negatively influence work satisfaction, whereas team interest, social responsibility and law and professional codes climate types are found to have positive impacts. Managerial and further research implications of the findings are discussed. (shrink)

Traditionally, research focused on determining the causes of employee pay satisfaction has investigated the influence of job-related inputs, both extrinsic and intrinsic to the job itself. Together with these inputs, pay-related fairness issues have played an important role in explaining the phenomenon. However, few studies consider the factors linked to fairness issues, such as ethical leadership. Because ethical leadership necessarily entails the concept of fairness, it seemingly should have a positive effect. Furthermore, because the presence of supervisor ethical leadership (...) (SEL) offers strong chances for employees to achieve moral accomplishments and excel in the practice of their jobs, SEL should enhance the effects of intrinsic job inputs. Whereas high job motivating potential (JMP) makes it easier for employees be self-actualized, moral fulfillment is necessary for them to obtain authentic self-actualization at work and minimize the impact of pay deficiencies. Along with SEL, JMP should be shaped to increase positive experiences of job meaningfulness, responsibility for job outcomes, and knowledge of results at work, which can lead to enjoyment in doing the job in itself, not just for compensation-related motives. Hierarchical regression analysis with a sample of 151 employees in a diverse set of Spanish organizations supports the direct effects of JMP and SEL and shows that higher levels of SEL increase the positive effects of JMP on pay satisfaction. The practical implications of these findings and further research directions conclude this article. (shrink)

Background: The global COVID-19 pandemic has imposed challenges on healthcare systems and professionals worldwide and introduced a ´maelstrom´ of ethical dilemmas. How ethically demanding situations are handled affects employees’ moral stress and job satisfaction. Aim: Describe priority-setting dilemmas, moral distress and support experienced by nurses and physicians across medical specialties in the early phase of the COVID-19 pandemic in Western Norway. Research design: A cross-sectional hospital-based survey was conducted from 23 April to 11 May 2020. Ethical considerations: (...) Ethical approval granted by the Regional Research Ethics Committee in Western Norway (131421). Findings: Among the 1606 respondents, 67% had experienced priority-setting dilemmas the previous two weeks. Healthcare workers who were directly involved in COVID-19 care, were redeployed or worked in psychiatry/addiction medicine experienced it more often. Although 59% of the respondents had seen adverse consequences due to resource scarcity, severe consequences were rare. Moral distress levels were generally low (2.9 on a 0–10 scale), but higher in selected groups (redeployed, managers and working in psychiatry/addiction medicine). Backing from existing collegial and managerial structures and routines, such as discussions with colleagues and receiving updates and information from managers that listened and acted upon feedback, were found more helpful than external support mechanisms. Priority-setting guidelines were also helpful. Discussion: By including all medical specialties, nurses and physicians, and various institutions, the study provides information on how the COVID-19 mitigation also influenced those not directly involved in the COVID-19 treatment of patients. In the next stages of the pandemic response, support for healthcare professionals directly involved in outbreak-affected patients, those redeployed or those most impacted by mitigation strategies must be a priority. Conclusion: Empirical research of healthcare workers experiences under a pandemic are important to identify groups at risks and useful support mechanisms. (shrink)

Background Implementing person-centred care (PCC) in nursing homes is challenging due to a gap between theory and practice. Bridging this gap requires suitable education, which focuses on learning how to attune care to the values and preferences of residents and take moral, relational, and situational aspects into account. Staff’s stories about the care they provide (i.e. caring stories) may deliver valuable insights for learning about these aspects. However, there is limited research on using staff's narratives for moral learning. (...) Objective This study aims to provide insight into the perspectives of nursing staff on using their caring stories to learn about PCC. Research design In this qualitative research, we conducted two rounds of interviews with 17 participants working in nursing homes. We wanted to obtain nursing staff’s perceptions of working with their caring stories and the impact on PCC. Ethical considerations Participation was voluntary, and participants provided written consent. The study protocol is approved by The Institutional Review Board of the Medical Ethical Committee Leiden-Den Haag-Delft. Findings Working with caring stories enables nursing staff to provide PCC and improves job satisfaction. It increases awareness of what matters to residents, fosters information rich in context and meaning, and enhances voice and vocabulary. Through in-depth team reflections, nursing staff discussed the significant moments for residents, which centralizes the discussions on the moral quality of care. Discussion Working with caring stories fosters dialogue on PCC and enhances reflection on ethical situations in daily encounters, contributing to the moral development of nursing staff. Putting nursing staff’s narratives at the centre of learning suits their daily practice and intrinsic motivation. Therefore, the outcomes of this study are an addition to the existing literature about using narratives in long-term care. Conclusion Using nursing staff's narratives contributes to PCC and positively impacts nursing staff. We recommend using staff's caring stories as a vehicle for moral learning in the transition to PCC. (shrink)

In Wayne Sumner argues that (1) as a matter of necessity, virtue is intrinsically prudentially rewarding, and (2) if all else is equal, the virtuous will fare better than the non-virtuous. In this article, I reproduce and criticize those arguments. I offer several objections to the argument for the first thesis; each objection makes the same basic point: contrary to what Sumner assumes, certain contingent facts over and above a person's being virtuous have to obtain if virtue is to issue (...) in any prudential reward. I object to Sumner's second thesis by arguing that moral neutrality can be at least as welfare-enhancing as moral virtuosity. Finally, I argue that even if virtue were intrinsically rewarding in the way Sumner envisions, it would still be impossible to determine a priori whether adopting a virtuous lifestyle would be prudentially rational. (shrink)

People have various desires, but it is a contested moral issue when a desire becomes of such importance that it legitimizes a moral claim on others. This paper explores how the normative significance of desire satisfaction can be assessed and argues that a normatively significant desire can constitute a pro tanto obligation to help satisfy it. The paper presents a framework that relates the normative significance of a given desire to the general goal of living a reasonably (...) valuable life and inquires how the latter can be given determinate content without excluding a heterogeneity of the personal good. The paper contends that the set of possibly normatively significant desires is thus restricted by considerations about intelligibility, adequacy, and replaceability, which are mediated by societal background theories. (shrink)

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)

Background Moral distress is a complex and challenging issue in the nursing profession that can negatively affect the nurses’ job satisfaction and retention and the quality of patient care. This study focused on describing the resources and constraints, consequences, and interventions of moral distress in nurses. Methods In a literature review, an extensive electronic search was conducted in databases including PubMed, ISI, Scopus as well as Google Scholar search engine using the keywords including “moral distress” and (...) “nurses” to identify resources, constraints, consequences, and interventions about moral distress in nurses, from the earliest records up to 26 December 2020. The required data were extracted from 61 relevant studies by two independent reviewers. Results Resources and constraints in the occurrence of moral distress among nurses can be divided into three general categories including internal factors, clinical factors, and external factors. The consequences of moral distress on nurses and the medical system reduced moral sensitivity, development of psychological and physical health problems, and the intention to leave the profession. The potential effective interventions were the implementation of integrated communication programs, strengthening physician–nurse collaboration, nursing involvement in clinical decision-making and end-of-life issues, social support, using a resiliency bundle, interdisciplinary discussion, and promoting nurses’ ethical and communication skills. Conclusion There are a wide range of resources and constraints impacting moral distress in nurses that could lead to negative consequences. Further studies are necessary to identify, evaluate, and implement a range of potential effective interventions for the management of moral distress in nurses. (shrink)

This article discusses some ethical principles for distributing pandemic influenza vaccine and other indivisible goods. I argue that a number of principles for distributing pandemic influenza vaccine recently adopted by several national governments are morally unacceptable because they put too much emphasis on utilitarian considerations, such as the ability of the individual to contribute to society. Instead, it would be better to distribute vaccine by setting up a lottery. The argument for this view is based on a purely consequentialist account (...) of morality; i.e. an action is right if and only if its outcome is optimal. However, unlike utilitarians I do not believe that alternatives should be ranked strictly according to the amount of happiness or preference satisfaction they bring about. Even a mere chance to get some vaccine matters morally, even if it is never realized. (shrink)

ABSTRACTThe philosophers of the self-styled ‘revolution in philosophy’ that went on to become the contemporary analytic tradition started a rumour about the British Idealists that has persisted to this day. Finding neither the substance of the idealist case, nor the style of idealistic writing, congenial to their modern taste, these Edwardians hinted that their Victorian forbears had argued from emotion rather than reason. No single paper could address this accusation across the board, for the movement in its entirety, and so (...) in this essay I focus on just one case, that of F. H. Bradley. Specifically, I identify the role he allows to feeling, emotion and what he terms ‘satisfaction’ in the determination of metaphysical and moral principles, and further ask whether the critics of idealism were right that there was something untoward in his approach. (shrink)

Healthcare workers experience moral injury (MI), a violation of their moral code due to circumstances beyond their control. MI threatens the healthcare workforce in all settings and leads to medical errors, depression/anxiety, and personal and occupational dysfunction, significantly affecting job satisfaction and retention. This article aims to differentiate concepts and define causes surrounding MI in healthcare. A narrative literature review was performed using SCOPUS, CINAHL, and PubMed for peer-reviewed journal articles published in English between 2017 and 2023. (...) Search terms included “moral injury” and “moral distress,” identifying 249 records. While individual risk factors predispose healthcare workers to MI, root causes stem from healthcare systems. Accumulation of moral stressors and potentially morally injurious events (PMIEs) (from administrative burden, institutional betrayal, lack of autonomy, corporatization of healthcare, and inadequate resources) result in MI. Individuals with MI develop moral resilience or residue, leading to burnout, job abandonment, and post-traumatic stress. Healthcare institutions should focus on administrative and climate interventions to prevent and address MI. Management should ensure autonomy, provide tangible support, reduce administrative burden, advocate for diversity of clinical healthcare roles in positions of interdisciplinary leadership, and communicate effectively. Strategies also exist for individuals to increase moral resilience, reducing the impact of moral stressors and PMIEs. (shrink)