Given the sensitive nature of trauma-focused research, it is important that researchers understand the impact of research participation on study participants. The current study examined the relationship between type of child abuse, psychological adjustment, and self-reported participatory distress in 105 female adult survivors of childhood abuse. Several key findings emerged: (a) overall, participants reported low levels of participatory distress; (b) greater levels of participatory distress were reported by sexual abuse survivors and were associated with (...) higher scores on depressed mood and posttraumatic stress; and (c) posttraumatic stress symptomatology served as a mediator in the relationship between abuse type and participatory distress. The findings inform researchers and members of Institutional Review Boards on variables related to participatory distress in studies of child abuse. (shrink)

Research question/aim/objectives Providing care for hospitalized children causes moral distress to nurses. Employee participation in discovering and solving the everyday problems of the workplace is one of the ways to hear the voices of nurses. This study aimed to evaluate the effect of participatory management programs on perceived organizational support and moral distress in pediatric nurses. Research design A quasi-experimental study. Participants and research context The present study was conducted on 114 pediatric nurses in Iran. Data were (...) collected using the Perceived Organizational Support Scale and the Moral Distress Scale of nurses. The intervention included implementing a participatory management program in three treatment departments that were randomly selected and it lasted 4 months. Participatory management was at the level of problem-solving with a focus on investigating, solving, and correcting issues and problems of work shifts and departments concerning the physical environment, equipment of the department, improvement of work processes, and team cooperation. In the control group, ordinary organizational approaches to problem-solving were used. Ethical considerations This study was approved by the Ethics Committee of Mashhad School of Nursing and Midwifery. Informed consent was obtained from the study participants. Findings/results Based on the results, both groups were homogenous before the intervention in terms of moral distress and perceived organizational support. The results showed that the moral distress mean scores in the intervention group decreased from 1.45 (0.52) to 1.03 (0.37) after the intervention. Also, the score of the perceived organizational support was 2.12 (1.2) increased after the intervention to 2.68 (1.10) in the intervention group. Conclusions It was found that the participation of nurses in the problem-solving process to solve daily workplace issues can be effective in increasing their perceived organizational support and reducing their moral distress. (shrink)

Background Moral distress is a serious problem for health care personnel. Surveys, individual interviews, and focus groups may not capture all of the effects of, and responses to, moral distress. Therefore, we used a new participatory action research approach—moral conflict assessment (MCA)—to characterize moral distress and to facilitate the development of interventions for this problem. Aim To characterize moral distress by analyzing responses of intensive care unit (ICU) personnel who participated in the MCA process. Research (...) Design In this qualitative study, we invited all ICU personnel at 3 urban hospitals to participate in individual or group sessions using the 8-step MCA tool. These sessions were facilitated by either a clinical ethicist or a counseling psychologist who was trained in this process. During each session, one of the researchers took notes and prepared a report for each MCA which were analyzed using qualitative content analysis. Participants and Research Context A total of 24 participants took part in 15 sessions, individually or in groups; 14 were nurses and nurse leaders, 2 were physicians, and 8 were other health professionals. Ethical Considerations This study was approved by the Providence Health Care/University of British Columbia Behavioural Research Ethics Board. Each participant provided written informed consent. Results The main causes of moral distress related to goals of care, communication, teamwork, respect for patient’s preferences, and the managerial system. Suggested solutions included communication strategies and educational activities for health care providers, patients, family members, and others about teamwork, advance directives, and end-of-life care. Participants acknowledged that using the MCA process helped them to reflect on their own thoughts and use their moral agency to turn a distressing situation into a learning and improvement opportunity. Conclusions Using the MCA tool helped participants to characterize their moral distress in a systematic way, and to arrive at new potential solutions. (shrink)

Background Levels of care deemed as inappropriate generate moral distress among nurses and other intensive care professionals. Inappropriate levels of care and related moral distress are frequently broached as individual and psychological phenomena, reduced to how individuals feel and think about specific cases. However, this tends to obscure the complex context in which these situations occur, and on which healthcare professionals can act. There is thus a need for a more contextual and team-level lens on inappropriate levels of (...) care. Research objective This study aims to explore and understand the issue of inappropriate levels of care in an intensive care unit (ICU) through a contextual and team-level lens. Research design Semi-structured interviews were conducted with nurses, respiratory therapists, and intensivists. Thematic analysis focused on understanding the causes and consequences of inappropriate levels of care, as well as potential avenues for improvement. This study is part of a 5-phase participatory living lab project on inappropriate levels of care conducted in the ICU of a Montreal (Quebec, Canada) hospital. This paper relates the initial phases of the project, focusing on understanding the issue, with reported events spanning from June 2022 to May 2023. Ethical considerations Ethics approval was sought and granted by the Research Ethics Board of the CIUSSS de l’Est-de-l’Île-de-Montréal. Findings/Discussion Five broad themes intrinsically related to the phenomenon of inappropriate levels of care were explored with and by participants: (1) the process of determining levels of care, (2) the distinction between appropriate and inappropriate levels of care, (3) causes of inappropriate levels of care, (4) consequences of inappropriate levels of care and (5) potential avenues for improvement. Conclusion This research provides a comprehensive understanding of inappropriate levels of care in the ICU and emphasizes the relevance of team-level explorations of complex ethical issues. (shrink)

Background: The management of challenging behaviours in inpatient with intellectual disability and/or autism spectrum disorders can lead to an escalation of control measures. In these complex situations where patients have an intellectual disability/autism spectrum disorder accompanied by a psychiatric comorbidity, the experiences of caregivers related to the crisis management have rarely been studied. Purpose: This study examined the moral experiences of caregivers related to challenging behaviours’ management and alternatives to control measures. Research design: Using Charles Taylor’s hermeneutic framework, a 2-month (...) focused ethnography with a participatory approach was used. Participants and research context: Sixteen caregivers were interviewed in a Canadian mental health setting for adults with intellectual disability/autism spectrum disorder and psychiatric comorbidity. Ethical considerations: The research was conducted in compliance with the Declaration of Helsinki and local Research Ethics Board approval. Written informed consent was collected systematically from participants. Findings: By accounting for caregivers’ moral experiences, this study sheds light on a neglected dimension of the care relationship: the vulnerability of the caregiver. We highlight the main barriers and facilitators to alternatives to control measures. First, a caregiver’s vulnerability was characterised by the overall impact of challenging behaviours and the moral distress associated with the use of control measures and exclusion mechanisms of intellectual disability/autism spectrum disorder patients. Second, a strong ambiguity between care and control measures and a lack of inclusive approaches were identified as the two main barriers to challenging behaviour management. Third, the involvement, both professional and personal, of caregivers was deemed necessary to implement alternatives to control measures. Discussion: A conflict of values opposes two conceptions of autonomy: a rational autonomy, which is counterproductive to the reduction of control measures, versus a relational autonomy based on shared vulnerability. Conclusion: The recognition of caregiver’s vulnerability is a benchmark to create alternative approaches, which defuse the logic of control and promote an ethics of care within which caregivers’ self-concern can be understood as fostering mutual respect. (shrink)

This paper explores the implications that arise when those of us with experiences of distress/mental health system encounters deploy lived experience as expertise to produce research. In recent years, some mental health service and research systems have conceded to disability rights demands of ‘nothing about us without us,’ and slowly, select people with direct contact with psychiatric systems and experiences of distress have been incorporated as experts by experience into mental health assemblages. In my own professional encounters, I (...) have largely benefited from these inclusive, participatory, and diversity-oriented best practices: using my experiences of distress, psychiatric encounters... (shrink)

This article deals with political socialization and political participation, in the context of visiting phenomenon, in Turkey. We took the Ali Baba Tomb in central Sivas and Celtek Baba Tomb in Celtek village as the sample of our study. In the study, political socialization and participation was seen as a dialectical process between individual and society. Visiting phenomenon embodying a rich historical, religious and cultural accumulation is important in that it defines the religious tendency of huge masses. As a matter (...) of fact, they have realized their potitical socialization in a pretty much authentic culture with different interests, duties, roles and positions. At the same time, they have shown their political participation with reference to the religious world of meaning. -/- SUMMARY In the contrast to the secular paradigm, religion continues to keep its reciprocal relations with the whole social system without giving an opportunity to any speculation. Religion and politics are two important fields in which this living relationship is stood for institutional structures. This article focuses on political socialization and political participation in Turkey by taking into consideration the phenomenon of visiting. The question of how the visiting phenomenon provided an input to the political system in terms of political socialization and political participation constitutes the problem of the research. Ali Baba Tomb in the center of Sivas province and Celtek Baba Tomb situated in central Celtek Village were selected as samples for the study. The political socialization and participation were talked with 33 visitors who had been selected randomly from different days between September and December 2015 and were tried to understand the data obtained by semi-standardized interview form. It has been examined in terms of its historical development and orientation of relationship between the visiting phenomenon in the research and the political system. For this reason, the basic methodological acceptance of the research has been to understand and interpret political socialization and participation in its specific environment. In this framework, firstly, the socialization of the sample in the context of family, school, mass communication and social environment was evaluated. Later, it has been tried to understand the religiousness in the context of the visiting through the same group. Their political participation has also been resolved according to the classification of Milbrath and Goel’s hierarchical political participation level through the field of political socialization and religiousness. Finally, this research, which is considered as a singular case study, has been subjected to a systematic and phenomenological analysis according to gender, age, education and belief variables on the basis of data obtained through problem-centered interviewing and participatory observation. The visiting in a phenomenological sense involves a trip and travel made with certain requests to the people who are believed to have been buried in places such as tombs, attributed to certain spiritual powers and virtues. The visiting phenomenon in the field of research had brought a rich historical and cultural content, exceeding a simple grave visit. Today, in the religious and traditional meaning world the traumas caused by the modernization and other socio-psychological thrillers have brought a different interest in Turkish society than ever before. The visiting phenomenon has created a continuity with a perception of sanctity and understanding which were shaped by an interaction with many different cultures, pre-Islamic beliefs and eventually mystical and charismatic personalities. However, the visiting phenomenon according to the severity of the individual and social crises experienced in the modern period has also revealed some variations that included popular patterns in both structural and practical contexts. Thus, the visiting phenomenon today is seen in a change by creating new universes appropriate to tradition in different social categories. In the modern era the influence of this change on the political culture is evident. This effect is generally related to the social structure of Turkish society and manifests itself as a closing within the sense of protection of the world of meaning. The visiting phenomenon, which has a special place in the religious life of very large masses in Turkey, has created a peculiar structure of political socialization and political participation around a profound historical accumulation. The participants have realized their political socialization in a unique cultural environment. This culture was formed in the context of family, school, mass communication and social environment. The dramatic situations that have taken place in the process have brought the important socialization problems in this environment. The community associations, the system of obsolete values, the distorted hierarchical relationships and the insecure environments created no longer lead to the searching for meaning by them. These people, who express themselves not like politics (27 people) at last, instead of expressing politics themselves with ideological concepts like ideological rightist, leftist, Islamist, communities people (ʾumma), Kemalist (5 people), but rather Turkish, Muslim, homeland, nation, human and righteousness as the concepts and words to prefer to identify. This should be a socialization that they carry out by transferring the objective world they created outwardly around a set of meanings to their subjective consciousness again. It should be a socialization again that they carry out by transferring the objective world they created outwardly around a set of meanings to their subjective consciousness. The visitors have carried out a political participation with the accumulation created by this field of political socialization. They saw themselves as often religious and the visiting activity as a sign of religiosity. As a result, the visiting a tomb could have been a simple manifestation of inner happiness and ease in a happy moment or an entertainment as much as it was in distress in this environment. The mystical attitude which is far from the world that many poor people built around the visit has caused them to put reserves in the political institution that represents a secular field. As a matter of fact, the visitors often characterize the world with the terms like empty, lie, trial, and so on. Politics, on the other hand, had been seen as a relationship of interest, cheating and lying. It has been understood that it provides a political input in the framework that Milbrath and Goel conceptualize as audience actions when we look at the political participation of the visiting phenomenon in the Sivas universe. According to this visit, in the sample of the phenomenon 29 people of the participants said that they are not open to the politics while 4 of them said that they are open to the politics. However, given that voting attitudes in the elections, only 2 of the participants did not see this very important; others (31 people) regard voting as a responsibility in the name of country, nation, country or even religion. From time to time, those who say either that they have started to the political discussions or that they have participated in political debates (11 people of them) are less than those who have never attended this kind of debates (22 people). In this sample, the number of people trying to persuade a person to vote for a particular party is 6; the number of people carrying a rosette of a party or hanging the symbols of the party to the house, to the car, was only 4 among those participants. Visiting people usually provide the political socializations in a fatalistic and restrictive environment. Their political participation is also in accord with the symbolic world of this hierarchical structure in which life is defined by certain rules. Therefore, they had produced an unquestionability of the authority as it is in family as well as political institutions. The politics is frightening for them; it is not interested in them and they should be away from it. (shrink)

The present study examines 1- to 5-year-old children’s emotion socialization in an early childhood educational setting (a preschool) in Sweden. Specifically, it examines social situations where teachers respond to children’s negative emotional expressions and negatively emotionally charged social acts, characterized by anger, irritation and distress. Data consist of 14 hours of video observations of daily activities, recorded in a public Swedish preschool, located in a suburban middle-class area and include 35 children and five preschool teachers. By adopting a sociocultural (...) perspective on children’s development and socialization, the study examines the communicative practices through which the expressions of negative emotions are responded to and the norms and values that are communicated through these practices. The data are analysed by using multimodal analysis of interaction that provides a tool for detailed analysis of participants’ verbal and embodied actions and sense-making. The analyses show that teachers responded to children’s negatively charged emotional expressions as social acts (that were normatively evaluated) and the adults instructed children how to modify their social conduct (rather than deploying explicit discussions about emotions). The teachers used communicative genres that prioritized general moral principles and implemented the non-negotiability of norms over individual children’s emotional-volitional perspectives and individual preferences. The teachers’ instructive socializing activities were characterized by movement between multiple temporal horizons, i.e., general (emotional) discourse that transcended the here-and-now, and specific instructions targeting the children’s conduct in a current situation. The study discusses how emotion socialization can be related to the institutional characteristics and collective participatory social conditions of early childhood education. (shrink)

Background The scrutiny surrounding gender-affirming medical treatment (GAMT) for youth has increased, particularly concerning the limited evidence on long-term treatment outcomes. The Standards of Care 8 by the World Professional Association for Transgender Health addresses this by outlining research evidence suggesting “effective” outcomes of GAMT for adolescents. However, claims concerning what are considered “effective” outcomes of GAMT for adolescents remain implicit, requiring further reflection. Methods Using trans negativity as a theoretical lens, we conducted a theory-informed reflexive thematic analysis of the (...) literature cited in the “Research Evidence” section of the SOC8 Adolescents chapter. We selected 16 articles that used quantitative measures to assess GAMT outcomes for youth, examining how “effective” outcomes were framed and interpreted to uncover implicit and explicit normative assumptions within the evidence base. Results A total of 44 different measures were used to assess GAMT outcomes for youth, covering physical, psychological, and psychosocial constructs. We identified four main themes regarding the normative assumptions of “effective” treatment outcomes: (1) doing bad: experiencing distress before GAMT, (2) moving toward a static gender identity and binary presentation, (3) doing better: overall improvement after GAMT, and (4) the absence of regret. These themes reveal implicit norms about what GAMT for youth should achieve, with improvement being the benchmark for “effectiveness.” Discussion We critically reflect on these themes through the lens of trans negativity to challenge what constitutes “effective” GAMT outcomes for youth. We explore how improvement justifies GAMT for youth and address the limitations of this notion. Conclusions We emphasize the need for an explicit discussion on the objectives of GAMT for adolescents. The linear narrative of improvement in GAMT for adolescents is limited and fails to capture the complexity of GAMT experiences. With currently no consensus on how the “effectiveness” of GAMT for adolescents is assessed, this article calls for participatory action research that centers the voices of young TGD individuals. (shrink)

Sex workers in the Netherlands experienced severe financial and social distress during the COVID-19 health crisis. Notwithstanding them paying taxes over the earnings, they were excluded from government financial support, faced discriminatory treatment concerning safe reopening, and experienced increased repression and stigmatization. In this contribution, I explore whether the concept of “vulnerability” contributes to understanding (and addressing) that situation. Data acquired through participatory action research, partly taking place online during lock-down measures, and literature and content analysis show that (...) labeling sex workers “vulnerable” deflects attention away from the (in)actions of Dutch authorities responsible for sex workers’ precarious conditions during the pandemic. Government denial and strategies of abjection explain these conditions better than “vulnerability” does, as they return the gaze to actors and processes accountable for sex workers’ exclusion and criminalization during the COVID-19 health crisis and thereby put responsibility where it belongs. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Whose Voice Matters? The Role of Ethics Consultation in Supporting the 16-Year-Old Healthcare Decision-Maker of a Critically Ill NeonateMichelle ProngEditor’s Note. The details of the patient case presented below have been modified to protect the family’s privacy. Despite these modifications, the author has made every effort to preserve the story’s clinical, social, and ethical nuances.The patient was born at 31 weeks with Trisomy 13 and lived her entire life (...) in the NICU. She was born to a 16-year-old mother (who I will call M.H.) as the result of an unintended pregnancy. This child was just about a month old when I became part of her care team. The patient was born with a severe congenital heart defect that our pediatric cardiac surgery team—as well as surgical teams at multiple other academic children’s hospitals—determined to be inoperable. Because of her severe heart defect, she required significant respiratory support throughout her life and continuous IV medications to keep her organs perfused.When I came on service, M.H. visited irregularly and depended on her mother (the patient’s grandmother, who I will call D.R.) for transportation. Social work had arranged for M.H. to have daily transportation to the hospital after school and work; however, M.H. was denied the opportunity to spend the night with her infant. It was against hospital policy for minors to stay overnight as visitors, and additional visitation guidelines related to COVID precautions were also in place at the time. As her biological mother, M.H. was designated as the patient’s healthcare decision-maker. The inability for M.H. to stay overnight on the basis of her age despite being the patient’s parent and healthcare decision-maker generated significant moral distress for several members of the care team. The social dynamic between M.H. and D.R. was such that D.R. was far more participatory in rounds and goals of care conversations, and M.H. was almost always reserved and withdrawn. On multiple occasions, different team members attempted to have conversations directly with M.H. She either was not engaged in the conversation, would answer with short phrases, or, when D.R. was present, would defer to D.R. to speak for her.Throughout the patient’s life, D.R. seemed to be the driving force behind most treatment and goals of care decisions. In multiple conversations I had with the family, both one-on-one with M.H. and jointly with M.H. and D.R., it was made clear that they wanted “everything done” and were hopeful for “a miracle.” D.R. emphasized that she didn’t want anyone to “give up” on the patient and wanted to exhaust all possible options for a cure. Overall, our team had become increasingly concerned that the medical decision makers for this patient did not comprehend the very poor prognosis of her congenital cardiac anomaly, either with or without surgery. As the medical team, we would be subjecting this child to harm that would be unlikely to change her prognosis. [End Page 19]Our NICU team, as well as various other teams, discussed the case repeatedly without a resolution that felt satisfactory. A complicating factor for this particularly socially and ethically challenging case was that the team turned over relatively frequently during the patient’s long-term stay, making it difficult for each successive team to understand what had already been done for this patient and her family. We decided to seek help from the Clinical Ethics Consulting (CEC) service. My expectation for the CEC service was that the consultant would help our team think differently about both the clinical and social elements of the situation and help us come to a resolution since we could not figure out a good solution on our own.Our consult question for the CEC was fourfold: 1) Did the patient’s mother meet criteria for an emancipated minor (to get around the visitation policy), 2) Is M.H. the appropriate healthcare decision maker given her lack of engagement in goals of care conversations and perceived understanding of the severity of her... (shrink)

The aim of the chapter is to discuss and evaluate the epistemic role of emotions in participatory sense-making, assuming 4Ecognition as background. I first ask why could emotions be beneficial for the collective processes of knowledge, especially discussing Battaly and arguing for a conceptualisation of emotions as socially extended motivations in virtue epistemology; then, I discuss participatory sense-making, both conceptually and phenomenologically, arguing for a fundamental role played by emotions in boosting epistemic cooperation and determining the quality of (...) social bonds. I advocate their specific function in epistemic cooperation. Epistemic cooperation is what brings about the generation of a shared meaning in participatory sense-making and thus, since emotions function as socially extended motivations, they boost the relationships among the agents, bonding them to the aims of their epistemic community. (shrink)

As yet, there is no enactive account of social cognition. This paper extends the enactive concept of sense-making into the social domain. It takes as its departure point the process of interaction between individuals in a social encounter. It is a well-established finding that individuals can and generally do coordinate their movements and utterances in such situations. We argue that the interaction process can take on a form of autonomy. This allows us to reframe the problem of social cognition as (...) that of how meaning is generated and transformed in the interplay between the unfolding interaction process and the individuals engaged in it. The notion of sense-making in this realm becomes participatory sense-making. The onus of social understanding thus moves away from strictly the individual only. (shrink)

Moral distress has received much attention in the international nursing literature in recent years. In this article, we describe the evolution of the concept of moral distress among nursing theorists from its initial delineation by the philosopher Jameton to its subsequent deployment as an umbrella concept describing the impact of moral constraints on health professionals and the patients for whom they care. The article raises worries about the way in which the concept of moral distress has been (...) portrayed in some nursing research and expresses concern about the fact that research, so far, has been largely confined to determining the prevalence of experiences of moral distress among nurses. We conclude by proposing a reconsideration, possible reconstruction and multidisciplinary approach to understanding the experiences of all health professionals who have to make difficult moral judgements and decisions in complex situations. (shrink)

Moral distress has been characterised in the nursing literature as a major problem affecting nurses in all healthcare systems. It has been portrayed as threatening the integrity of nurses and ultimately the quality of patient care. However, nursing discourse on moral distress is not without controversy. The notion itself is conceptually flawed and suffers from both theoretical and practical difficulties. Nursing research investigating moral distress is also problematic on account of being methodologically weak and disparate. Moreover, the (...) ultimate purpose and significance of the research is unclear. In light of these considerations, it is contended that the notion of moral distress ought to be abandoned and that concerted attention be given to advancing inquiries that are more conducive to improving the quality and safety of moral decision-making, moral conduct and moral outcomes in nursing and healthcare domains. (shrink)

The enactive approach to cognition distinctively emphasizes autonomy, adaptivity, agency, meaning, experience, and interaction. Taken together, these principles can provide the new sciences of language with a comprehensive philosophical framework: languaging as adaptive social sense-making. This is a refinement and advancement on Maturana’s idea of languaging as a manner of living. Overcoming limitations in Maturana’s initial formulation of languaging is one of three motivations for this paper. Another is to give a response to skeptics who challenge enactivism to connect “lower-level” (...) sense-making with “higher-order” sophisticated moves like those commonly ascribed to language. Our primary goal is to contribute a positive story developed from the enactive account of social cognition, participatory sense-making. This concept is put into play in two different philosophical models, which respectively chronicle the logical and ontogenetic development of languaging as a particular form of social agency. Languaging emerges from the interplay of coordination and exploration inherent in the primordial tensions of participatory sense-making between individual and interactive norms; it is a practice that transcends the self-other boundary and enables agents to regulate self and other as well as interaction couplings. Linguistic sense-makers are those who negotiate interactive and internalized ways of meta-regulating the moment-to-moment activities of living and cognizing. Sense-makers in enlanguaged environments incorporate sensitivities, roles, and powers into their unique yet intelligible linguistic bodies. We dissolve the problematic dichotomies of high/low, online/offline, and linguistic/nonlinguistic cognition, and we provide new boundary criteria for specifying languaging as a prevalent kind of human social sense-making. (shrink)

Background: Moral distress, defined as moral suffering or a psychological imbalance, can affect nursing students. However, many new instruments or adaptations of other scales that are typically used to measure moral distress have not been used for nursing students. Aim: This study aimed to translate, culturally adapt and evaluate the psychometric properties of an Italian version of the Moral Distress Scale for Nursing Students (It-ESMEE) for use with delayed nursing students (students who could not graduate on time (...) or failed the exams necessary to progress to the next level). Research design: The study used a cross-sectional research design. Participants and research context: Incidental sampling resulted in a sample of 282 delayed nursing students (mean age = 26.73 ± 4.43 years, 73% female) enrolled between May and August 2020 in a University of central Italy. Ethical considerations: The research protocol was approved by the internal review board of the university, and all participants provided their written informed consent. Results: The study confirmed a multidimensional second-order factorial structure for the It-ESMEE with five dimensions: improper institutional conditions to teach user care, authoritarian teaching practices, disrespect for the ethical dimension of vocational training, lack of competence of the teacher and commitment of ethical dimension of user care. The internal consistency was high (0.753–0.990 across the factors), and the standard error of measurement and smallest detectable change were adequate. Discussion: The It-ESMEE is able to assess moral distress in delayed nursing students with good validity and reliability. It can be used in research and to determine moral distress levels, helping teachers to monitor the condition in nursing students. Conclusion: This instrument can help in comprehending moral distress, enabling students to develop coping and intervention strategies to maintain their well-being, and to ensure the quality of nurse education. (shrink)

Religion constitutes an important element in every society as regards coping with the demands as well as vicissitudes of life. Mental health issues are becoming a recurrent decimal in societies overwhelmed by stress and other social factors. This paper examines how the presence of religious beliefs affects how some Christians respond to cases that have to do mental health. At the same time, it surveys how a near absence of religious attitude, that is, clinical medicine approach to mental health issues (...) betters the state of those suffering from these psychopathologies. This work sees participatory partnership approach as an effective means of correcting unhealthy biases that prevent a better understanding of mental health care. Sociological theory of structural functionalism will be used in assessing how religion can reinvent itself in areas that are associated with mental health. Ethnographic methodology through quantitative analysis of administered questionnaire is used as a research tool for this research. Three persons were also interviewed. The research findings show that religion is a crucial agent of socialization that can change how religious beliefs impact on mental health and there is need for medical professionals to collaborate with pastoral agents. (shrink)

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)

Nurses are frequently confronted with ethical dilemmas in their nursing practice. As a consequence, nurses report experiencing moral distress. The aim of this review was to synthesize the available quantitative evidence in the literature on moral distress experienced by nurses. We appraised 19 articles published between January 1984 and December 2011. This review revealed that many nurses experience moral distress associated with difficult care situations and feel burnout, which can have an impact on their professional position. Further (...) research is required to examine worksite strategies to support nurses in these situations and to develop coping strategies for dealing with moral distress. (shrink)

This paper empirically investigates the impact of cognitive board diversity in education, expertise, and tenure facets on financial distress likelihood in the emerging economy of China. This study examines how this relationship varies across State-Owned Enterprises and Non-State-Owned Enterprises. Paper argues that the Chinese stock market, as a typical emerging market, is an excellent laboratory for studying the impact of board diversity on the probability of financial distress. Its underdeveloped financial system and inadequate investor protection leave firms unprotected (...) from financial hardship. A sample of 12,366 observations from 1,374 firms from 2010 to 2018 shows that cognitive diversity qualities are positively linked with Z-score, implying that directors with different educational backgrounds, financial skills, and tenures can assist in reducing the probability of financial distress. Cognitive board diversity reduces the likelihood of financial distress in SOEs and NSOEs. However, tenure diversity is insignificant in all cases. Furthermore, the robustness model “two-step system Generalized Methods of Moments ” demonstrated a positive association between educational diversity, financial expertise, and financial distress scores. The results have significant implications for researchers, managers, investors, regulators, and policymakers. (shrink)

Much research is currently being conducted on health care practitioners' experiences of moral distress, especially the experience of nurses. What moral distress is, however, is not always clearly delineated and there is some debate as to how it should be defined. This article aims to help to clarify moral distress. My methodology consists primarily of a conceptual analysis, with especial focus on Andrew Jameton's influential description of moral distress. I will identify and aim to resolve two (...) sources of confusion about moral distress: the compound nature of a narrow definition of distress which stipulates a particular cause, i.e. moral constraint, and the distinction drawn between moral dilemma and moral distress, which implies that the two are mutually exclusive. In light of these concerns, I argue that the definition of moral distress should be revised so that moral constraint should not be a necessary condition of moral distress, and that moral conflict should be included as a potential cause of distress. Ultimately, I claim that moral distress should be understood as a specific psychological response to morally challenging situations such as those of moral constraint or moral conflict, or both. (shrink)

Unfortunately, there are still cases of domestic violence or situations where it is necessary to call for help without arousing the suspicion of the aggressor. In these situations, the help signal devised by the Canadian Women’s Foundation has proven to be effective in reporting a risky situation. By displaying a sequence of hand signals, it is possible to report that help is needed. This work presents a vision-based system that detects this sequence and implements it in a social robot, so (...) that it can automatically identify unwanted situations and alert the authorities. The gesture recognition pipeline presented in this work is integrated into a cognitive architecture used to generate behaviours in robots. In this way, the robot interacts with humans and is able to detect if a person is calling for help. In that case, the robot will act accordingly without alerting the aggressor. The proposed vision system uses the MediaPipe library to detect people in an image and locate the hands, from which it extracts a set of hand landmarks that identify which gesture is being made. By analysing the sequence of detected gestures, it can identify whether a person is performing the distress hand signal with an accuracy of 96.43%. (shrink)

The COVID-19 pandemic has challenged the world for a year, where a study in China showed that the disease increased psychological distress among adolescents and college students, such as anxiety about the academic setback, economic effects, and impact on their daily life. However, a further study examining the impact of the disease on the mental health of students is required. Social support is the most vital psychosocial protective resource, where effective coping can reduce stress levels and prevent individuals from (...) experiencing more severe psychological distress. Therefore, this study investigated the coping strategy, social support, and psychological distress among university students in Jakarta who are also the epicenter of COVID-19 in Indonesia. The psychological distress and coping strategy variable were measured through the Hopkins Symptoms Checklist-25 and the COPE Brief instrument, respectively. Meanwhile, the Multidimensional Perceived Social Support-12 instrument was used to measure the social support variable. The study was disseminated via an online form and the number of research subjects included 250 students who matched the research criteria, including DKI Jakarta domicile and active students registered in the area that were confirmed to be COVID-19 positive. According to the results, coping strategies and increased social support were significantly correlated with decreased psychological distress and may serve as the basis for interventions. (shrink)

Farmer participatory approaches were used to identify problems and needs as perceived by local people and to develop strategies to achieve fodder security in south Indian villages. Indigenous knowledge systems as they relate to agroforestry were explored. The farmer participatory approaches have laid the foundations for selecting appropriate agroforestry technologies and developing suitable fodder security policy options. Potential benefits and risks as a result of implementing agroforestry projects were also discussed.

In the Sheeb area in eastern Eritrea a Participatory Rural Appraisal(PRA) was carried out in two villages, one upstream and one downstreamof the ephemeral rivers Laba and Mai-ule. The objectives of the studywere to obtain a better understanding of farmer-managed spate irrigationsystems and to enable the local people to perform their own farmingsystem analysis. This paper describes the various PRA activities, suchas mapping, diagramming and ranking of problems, that were undertakenwith the participation of local people. The resource mapping revealedthat (...) lack of water and not scarcity of land is the main constraintaffecting the development of the spate irrigation system in the Sheebarea. When there is a lack of rainfall in the highlands of Eritrea,there are only few floods per year in the Sheeb area. The developmenttrend diagrams showed that the number of floods, the food production andthe prevalence of pests vary considerably over time. The livelihooddiagrams indicated that food, fodder, and water were only availableduring part of the year. In search of these resources, the farmers havedeveloped a livelihood strategy of seasonal migration to the highlandsof Eritrea. The PRA data collected in the two villages appeared to bevery useful for the preparation of community action plans in the entireSheeb area. (shrink)

With the development and increasing use of diverse public involvement methods over the past decade, formal technology assessment has shifted from a largely closed, intrainstitutional tool of policy analysis and advice to a tool for the social assessment of scientific-technological issues at the interface between politics and public discourse. Through citizens’ conferences, scenario workshops, and consensus conferences, technology assessment has effectively been opened up to the public sphere: Citizens and interest group representatives are drawn into the process of assessing scientific (...) and technological issues alongside experts, the process often takes place in public, and its outcomes are made widely available for information and debate. This article analyzes the public involvement agenda in technology assessment from the conceptual perspective of the “public sphere.” It discusses key features of public sphere–oriented technology assessment, including public access, actor involvement, and deliberation. And it considers the implications of the public sphere dimension for future developments in participatory technology assessment. (shrink)

In this article, we present participatory action research as a radical act of humanity: a direct response to real dehumanization of vulnerable communities. We argue, as an enactment of critic...

This article explores how citizen participation was methodologically devised and materially articulated in the postdisaster reconstruction of Constitución, one of the most affected cities after the earthquake and tsunami that battered south central Chile in 2010. I argue that the techniques deployed to engineer the participation were arranged as a policy experiment where a particular type of public was provoked—one characterized by its emotional detachment, political engagement, and social tolerance. The case of Constitución, however, also shows that this public ran (...) parallel to other forms of being a public not aligned with the experiment’s assumptions. More broadly, the article argues that while disaster studies need to acknowledge the generative capacities of public participation, science and technology studies should include disasters as a particular setting for participatory experiments. (shrink)

Once a term used primarily by moral philosophers, “moral distress” is increasingly used by health professionals to name experiences of frustration and failure in fulfilling moral obligations inherent to their fiduciary relationship with the public. Although such challenges have always been present, as has discord regarding the right thing to do in particular situations, there is a radical change in the degree and intensity of moral distress being expressed. Has the plight of professionals in healthcare practice changed? “Plight” (...) encompasses not only the act of pledging, but that of predicament and peril. The author claims that health professionals are increasingly put in peril by healthcare reform that undermines their efficacy and jeopardizes ethical engagement with those in their care. The re-engineering of healthcare to give precedence to corporate and commercial values and strategies of commodification, service rationing, streamlining, and measuring of “efficiency,” is literally demoralizing health professionals. Healthcare practice needs to be grounded in a capacity for compassion and empathy, as is evident in standards of practice and codes of ethics, and in the understanding of what it means to be a professional. Such grounding allows for humane response to the availability of unprecedented advances in biotechnological treatments, for genuine dialogue and the raising of difficult, necessary ethical questions, and for the mutual support of health professionals themselves. If healthcare environments are not understood as moral communities but rather as simulated marketplaces, then health professionals’ moral agency is diminished and their vulnerability to moral distress is exacerbated. Research in moral distress and relational ethics is used to support this claim. (shrink)

The coronavirus disease 2019 health crisis is strongly affecting the psychological well-being of the general population. According to a very recent literature, the imposed lockdown and social distancing measures have generated a series of negative outcomes, including fear of the future, anxiety, and somatization symptoms. Few studies have investigated the impact of the COVID-19 pandemic on the well-being of parents and children, and still fewer studies have assessed the relationship between the psychological health of parents and children. The present study (...) aimed at understanding the effect of parents’ psychological distress and verbal aggression on behavioral and emotional symptoms of children during the COVID-19 lockdown. Using an online survey administered in the first weeks of the lockdown in Italy, we explored the mediating effects of parent verbal hostility and child emotional symptoms on the relationship between parent distress and child hyperactivity/inattention in a sample of 878 Italian parents. Two hypotheses were proposed: parent distress would significantly predict child hyperactivity/inattention, and parent verbal hostility and child emotional symptoms would mediate the association between parent distress and child hyperactivity/inattention. The serial mediated model confirmed both hypotheses, suggesting that higher rates of psychological distress in parents were associated with higher levels of hyperactivity/inattention in children. Parent verbal hostility and child emotional problems were also found to positively mediate this relation. Our results may be used to improve sociopsychological interventions in the general population in the near future. They may also contribute to the clinical definition of therapeutic paths for parents and families. (shrink)

Background: Clinical research nurses experience unique challenges in the context of their role that can lead to conflict and moral distress. Although examined in many areas, moral distress has not been studied in clinical research nurses. Research aim: The aim of this study was to examine moral distress in clinical research nurses and the relationship between moral distress scores and demographic characteristics of clinical research nurses. Research design: This was a descriptive quantitative study to measure moral (...) distress in clinical research nurses using the Measure of Moral Distress – Healthcare Professionals (MMD-HP) administered electronically. Demographic data were also collected. Participants and research context: Registered nurses working in the clinical research nurse role ( N = 322) were recruited through use of social media, emails, digital flyers, and snowball recruitment. Data was analyzed using SPSS. Pearson’s correlation, independent t-test, and one-way ANOVA were performed to explore differences among the demographic variables. Ethical considerations: This study was approved by the Institutional Review Board at Texas Woman’s University. A consent statement was included, and completion of the questionnaire was construed as consent. Findings/results: Analysis revealed a mean overall moral distress score of 79.58 (SD = 64.27) and median of 67, with a range of 0–354. Moral distress scores were negatively correlated with clinical research nurse age ( r = 0-.156, p < 0.05). Reliability of the MMD-HP was demonstrated with a Cronbach’s alpha of 0.93. Conclusions: The findings demonstrate that clinical research nurses do experience moral distress and revealed a wide range of scores. Further research is necessary to determine potential patient impact due to moral distress and to develop processes to minimize moral distress in the clinical research setting. This study was conducted during the COVID-19 pandemic, and the digital recruitment methods proved effective in recruiting a wide range of clinical research nurses, both nationally and internationally. (shrink)

Background: Nurses and nursing students appear vulnerable to moral distress when faced with ethical dilemmas or decision-making in clinical practice. As a result, they may experience professional dissatisfaction and their relationships with patients, families, and colleagues may be compromised. The impact of moral distress may manifest as anger, feelings of guilt and frustration, a desire to give up the profession, loss of self-esteem, depression, and anxiety. Objectives: The purpose of this review was to describe how dilemmas and environmental, (...) relational, and organizational factors contribute to moral distress in undergraduate student nurses during their clinical experience and professional education. Research design: The research design was a systematic literature review. Method: The search produced a total of 157 articles published between 2004 and 2014. These were screened with the assessment sheet designed by Hawker and colleagues. Four articles matched the search criteria (one quantitative study and three qualitative), and these were separately read and analyzed by the researchers. The process of review and analysis of the data was supervised by a colleague experienced in moral distress who provided an independent quality check. Ethical consideration: Since this was a systematic review, no ethical approval was required. Findings: From the analysis, it emerged that inequalities and healthcare disparities, the relationship with the mentor, and students’ individual characteristics can all impact negatively on the decisions taken and the nursing care provided, generating moral distress. All these factors condition both the clinical experience and learning process, in addition to the professional development and the possible care choices of future nurses. Conclusion: Few studies dealt with moral distress in the setting of nurse education, and there is a knowledge gap related to this phenomenon. The results of this review underline the need for further research regarding interventions that can minimize moral distress in undergraduate nursing students. (shrink)

The discovery that certain selective serotonin reuptake inhibitors delay ejaculation and the later development and approval of dapoxetine as an on-demand treatment option has led to a dramatic increase in medical interest in premature ejaculation. This paper analyses the diagnostic criteria and the discussion within the medical community about suitable treatments against the backdrop of theories of science, sex and gender. Our conclusion is that the diagnosis itself and the suggested treatments contribute to normative models of sexual conduct and therefore (...) reinforce the norms that cause patients9 distress over ejaculating ‘too soon’. (shrink)

The aim of this study was to explore the existence of moral distress among nurses in Lilongwe District of Malawi. Qualitative research was conducted in selected health institutions of Lilongwe District in Malawi to assess knowledge and causes of moral distress among nurses and coping mechanisms and sources of support that are used by morally distressed nurses. Data were collected from a purposive sample of 20 nurses through in-depth interviews using a semi-structured interview guide. Thematic analysis of qualitative (...) data was used. The results show that nurses, irrespective of age, work experience and tribe, experienced moral distress related to patient/nursing care. The major distressing factors were inadequate resources and lack of respect from patients, guardians, peers and bosses. Nurses desire teamwork and ethics committees in their health institutions as a means of controlling and preventing moral distress. There is a need for creation of awareness for nurses to recognize and manage moral distress, thus optimizing their ability to provide quality and uncompromised nursing care. (shrink)

One of the difficulties nurses experience in clinical practice in relation to ethical issues in connection with young oncology patients is moral distress. In this descriptive correlational study, the Moral Distress Scale-Paediatric Version (MDS-PV) was translated from the original language and tested on a conventional sample of nurses working in paediatric oncology and haematology wards, in six north paediatric hospitals of Italy. 13.7% of the total respondents claimed that they had changed unit or hospital due to moral (...) class='Hi'>distress. The items with the highest mean intensity in the sample were almost all connected with medical and nursing competence and have considerably higher values than frequency. The instrument was found to be reliable. The results confirmed the validity of the MDS-PV (Cronbach’s alpha = 0.959). This study represents the first small-scale attempt to validate MDS-PV for use in paediatric oncology-ematology nurses in Italy. (shrink)

Research suggests that the incidence of moral distress experienced by health professionals is significant and increasing, yet the concept lacks clarity and remains largely misunderstood. Currently, there is limited understanding of moral distress in the context of midwifery practice. The term moral distress was first used to label the psychological distress experienced following complex ethical decision-making and moral constraint in nursing. The term is now used across multiple health professions including midwifery, nursing, pharmacy and medicine, yet (...) is used cautiously due to confusion regarding its theoretical and contextual basis. The aim of this study is to understand the concept of moral distress in the context of midwifery practice, describing the attributes, antecedents and consequences. This concept analysis uses Rodgers’ evolutionary framework and is the first stage of a sequential mixed-methods study. A literature search was conducted using multiple databases resulting in eight articles for review. Data were analysed using NVivo12©. Three core attributes were identified: moral actions and inactions, conflicting needs and negative feelings/emotions. The antecedents of clinical situations, moral awareness, uncertainty and constraint were identified. Consequences of moral distress include adverse personal professional and organisational outcomes. A model case depicting these aspects is presented. A midwifery focused definition of moral distress is offered as ‘a psychological suffering following clinical situations of moral uncertainty and/or constraint, which result in an experience of personal powerlessness where the midwife perceives an inability to preserve all competing moral commitments’. This concept analysis affirms the presence of moral distress in midwifery practice and provides evidence to move towards a consistent definition of moral distress. (shrink)

YOUNG L, and WHARF HIGGINS J.Nursing Inquiry2010;17: 346–358 Using participatory research to challenge the status quo for women’s cardiovascular healthCardiovascular health research has been dominated by medical and patriarchal paradigms, minimizing a broader perspective of causes of disease. Socioeconomic status as a risk for cardiovascular disease is well established by research, yet these findings have had little influence. Participatory research (PR) that frames mixed method research has potential to bring contextualized clinically relevant findings into program planning and policy‐making (...) arenas toward developing meaningful health and social policies relevant to primary prevention. In this article we provide an overview of a PR program that included two quantitative and one qualitative studies and then we discuss lessons learned. The PR process we found was empowering for lone mothers, and transformative for lone mothers and researchers. Further, PR as an approach to research opened spaces in practice and policy‐making arenas to raise upstream issues relevant to the health of low income lone mothers. We conclude that while PR is an effective approach to social determinants research, as a time‐intensive endeavor, and one that does not easily align with research tradition, researchers must consider the strengths and drawbacks of PR when planning to implement such an approach. (shrink)

As at a high-risk group of psychological distress, nurses generally experience varying degrees of stress, anxiety, and depression. This paper identifies the positive factors that may negatively regulate the psychological pain of clinical nurses and their mechanisms of action, providing reliable references for clinical nurse support management. The effects and mechanisms of hope and the two components of grit consistency of interest and perseverance of effort) on clinical nurses’ psychological distress were observed in this study. A total of (...) 635 Chinese clinical nurses completed an anonymous questionnaire for the survey. As expected, hope, consistency of interest, and perseverance of effort were negatively correlated with the three indicators of psychological distress. Path analysis results showed that hope significantly mediated the negative effect of consistency of interest on psychological distress, with an effect of 12.96%. Hope also covered up the perseverance of effort on psychological distress, the effect of 110.63%. In the influence of consistency of interest and perseverance of effort on psychological distress, hope contributed a vital mediating. Based on these results, it can be concluded that grit and hope have protective effects on psychological distress in clinical nurses. Significantly increasing the level of hope or grit may effectively prevent and reduce psychological distress in clinical nurses. (shrink)

While various definitions of moral distress have been proposed, some agreement exists that it results from illegitimate constraints in clinical practice affecting healthcare professionals’ moral agency. If we are to reduce moral distress, instruments measuring it should provide relevant information about such illegitimate constraints. Unfortunately, existing instruments fail to do so. We discuss here several shortcomings of major instruments in use: their inability to determine whether reports of moral distress involve an accurate assessment of the requisite clinical (...) and logistical facts in play, whether the distress in question is aptly characterized as moral, and whether the moral distress reported is an appropriate target of elimination. Such failures seriously limit the ability of empirical work on moral distress to foster appropriate change. (shrink)

Moral distress is now being recognized as a frequent experience for many health care providers, and there's good evidence that it has a negative impact on the health care work environment. However, contemporary discussions of moral distress have several problems. First, they tend to rely on inadequate characterizations of moral distress. As a result, subsequent investigations regarding the frequency and consequences of moral distress often proceed without a clear understanding of the phenomenon being discussed, and thereby (...) risk substantially misrepresenting the nature, frequency, and possible consequences of moral distress. These discussions also minimize the intrinsically harmful aspects of moral distress. This is a serious omission. Moral distress doesn't just have a negative impact on the health care work environment; it also directly harms the one who experiences it. In this paper, I claim that these problems can be addressed by first clarifying our understanding of moral distress, and then identifying what makes moral distress intrinsically harmful. I begin by identifying three common mistakes that characterizations of moral distress tend to make, and explaining why these mistakes are problematic. Next, I offer an account of moral distress that avoids these mistakes. Then, I defend the claim that moral distress is intrinsically harmful to the subject who experiences it. I conclude by explaining how acknowledging this aspect of moral distress should reshape our discussions about how best to deal with this phenomenon. (shrink)

Examining the concept of clientelism in analysis of participatory processes, we investigate how collective and individual action are articulated in practices in the case of participatory budgeting in Recife, Brazil. We use ethnographic work to look how collective actors mobilize within the PB process in Recife and show that PB’s territorial and redistributive nature provides fertile ground for informal exchanges to be entrenched in institutional processes at the micro level. Microsocial interactions between political entrepreneurs, intermediaries, and ordinary participants (...) in Recife participatory practice are shaped by two processes: individualization of political loyalties and territorialization of politics. These, we argue, allow informal exchanges to coexist with institutionalized forms of collective action. PB presupposes that participants engage in local struggles and introduces competition and inequalities among them, as access to resources is conditioned by their ability to mobilize and enter into informal interactions that underlie political exchanges within PB. (shrink)

Food systems are made of a myriad of actors, visions and interests. Collaborative governance arrangement may foster their transformation towards greater sustainability when conventional means, such as state-oriented planning, technological developments or social innovations provide insufficient impetus. However, such arrangements may achieve transformative results only under certain conditions and in specific contexts. Despite an abundant literature on participatory schemes, the success for collaborative governance arrangements remains partially understood and deserves academic attention, in particular in the field of food systems (...) reform. This article provides an in-depth analysis of an empirical case study in the Walloon Region (Belgium), where the administration for sustainable development initiated a six-month participatory process to collectively construct a roadmap towards a sustainable regional food system. The article explores the extent to which the process has allowed transformative voices to emerge, and assesses whether the outcome provides a promising tool for adopting a transformative policy at the regional scale. It argues that the facilitation process insufficiently attenuated existing power relations and highlights key underlying factors (including time, resources, expertise and coalition building) that, like in classical negotiation settings, strengthen or weaken specific actors. It discusses the link between the results of the participatory process and the potential for policy-makers to build upon these to guide further the region’s food system towards a sustainable future. (shrink)

Background: Moral distress occurs when constraints prevent healthcare providers from acting in accordance with their core moral values to provide good patient care. The experience of moral distress in nurses might be magnified during the current Covid-19 pandemic. Objective: To explore causes of moral distress in nurses caring for Covid-19 patients and identify strategies to enhance their moral resiliency. Research design: A qualitative study using a qualitative content analysis of focus group discussions and in-depth interviews. We purposively (...) sampled 31 nurses caring for Covid-19 patients in the acute care units within large academic medical systems in Maryland and New York City during April to June 2020. Ethical considerations: We obtained approval from the Institutional Review Board at the University of Maryland, Baltimore. Results: We identified themes and sub-themes representative of major causes of moral distress in nurses caring Covid-19 patients. These included (a) lack of knowledge and uncertainty regarding how to treat a new illness; (b) being overwhelmed by the depth and breadth of the Covid-19 illness; (c) fear of exposure to the virus leading to suboptimal care; (d) adopting a team model of nursing care that caused intra-professional tensions and miscommunications; (e) policies to reduce viral transmission (visitation policy and PPE policy) that prevented nurses to assume their caring role; (f) practicing within crisis standards of care; and (g) dealing with medical resource scarcity. Participants discussed their coping mechanisms and suggested future strategies. Discussion/Conclusion: Our study affirms new causes of moral distress related to the Covid-19 pandemic. Institutions need to develop a supportive ethical climate that can restore nurses’ moral resiliency. Such a climate should include non-hierarchical interdisciplinary spaces where all providers can meet together as moral peers to discuss their experiences. (shrink)

Their nursing experience and/or training may lead students preparing for the nursing profession to have less moral distress and more favorable attitudes towards a hastened death compared with those preparing for other fields of study. To ascertain if this was true, 66 undergraduates (54 women, 9 men, 3 not stated) in southeastern USA completed measures of moral distress and attitudes towards hastening death. Unexpectedly, the results from nursing and non-nursing majors were not significantly different. All the present students (...) reported moderate moral distress and strong resistance to any efforts to hasten death but these factors were not significantly correlated. However, in the small sample of nurses in training, the results suggest that hastened death situations may not be a prime reason for moral distress. (shrink)

Soccer players inescapably live under stress during the sportive career, and many real-life aspects of soccer situations operate in the ongoing performance. This study’s main objective was to elaborate the List of Stressors in Professional Indoor and Field Soccer, a self-report instrument designed to measure the impact of 77 soccer situations upon the sport performance. Participants were 138 indoor and field soccer players from the Brazilian Premier League. Each situation was evaluated on a 7-point scale, ranging from the most negative (...) to the most positive. Data were analyzed according to the players’ perception of the items: distress or eustress and its intensity, and after that, situations perceived as plus −1 and +1 were compared by time in which they were experienced and distributed among five categories established by the literature: Expectations about the Performance, Personal Factors, Competition Aspects, Training Demands, and Relationship with Significant People. Narratives of athletes’ experiences were also used to discuss the results. An Exploratory Structural Equation Modeling using Bi-factorial was employed to assess the factor structure. For the total participants, 49 situations were perceived as distress and 28 as eustress. Using the criteria established a priori, the distribution was among the five categories in the remaining 32 situations. Differences in perception between less and more experienced players were found in 11 situations. The results revealed that Brazilian professional soccer players experience various stressful situations. These events are important representations of environmental demands and could predict the performance as they are perceived as eustress or distress. Some of these stressful situations are inherent in sport and others adjacent to the sports system or environment. Coach pressure to win and conflicts with teammates are examples of stressors in-sport, family problems and disputes with press or fans are examples of stressors external to the team, also called peripheral opponents, and showed the relative social influence of significant others in soccer performance. We can conclude that the knowledge of the direction of a given stress situation has important practical implications in preparing athletes and helping them face the performance stressors that are part of soccer daily life. (shrink)

ObjectiveApproximately half of all people living with amyotrophic lateral sclerosis experience persistent or recurrent emotional distress, yet little is known about the psychological processes that maintain emotional distress in this population. The self-regulatory executive functioning model specifies that maladaptive metacognitive beliefs and processes are central to the development and maintenance of emotional distress. This study explored whether maladaptive metacognitive beliefs are associated with emotional distress after controlling for demographic factors, time since diagnosis, and current level of (...) physical functioning.DesignIn a cross-sectional design, 75 adults with a diagnosis of ALS completed self-report questionnaires. Participants had a mean age of 60.40 years, mean duration of symptoms 63.92 months, and male:female gender ratio of 14:11.Main Outcome MeasuresQuestionnaires assessed emotional distress, physical functioning, repetitive negative thinking, metacognitive beliefs, and demographic factors.ResultsMaladaptive metacognitive beliefs explained additional variance in emotional distress after controlling for age, gender, time since diagnosis, physical functioning, and repetitive negative thinking. Repetitive negative thinking partially mediated the relationships between positive and negative metacognitive beliefs and emotional distress.ConclusionsThese data support the utility of the metacognitive model in understanding emotional distress in people with ALS. Examination of the temporal relationship between maladaptive metacognitive beliefs and emotional distress in people living with ALS may help to guide the development of therapeutic approaches. (shrink)

Moral distress has been written about extensively in nursing and other fields. Often, however, it has not been used with much theoretical depth. This paper focuses on theorizing moral distress using feminist ethics, particularly the work of Margaret Urban Walker and Hilde Lindemann. Incorporating empirical findings, we argue that moral distress is the response to constraints experienced by nurses to their moral identities, responsibilities, and relationships. We recommend that health professionals get assistance in accounting for and communicating (...) their values and responsibilities in situations of moral distress. We also discuss the importance of nurses creating “counterstories” of their work as knowledgeable and trustworthy professionals to repair their damaged moral identities, and, finally, we recommend that efforts toward shifting the goal of health care away from the prolongation of life at all costs to the relief of suffering to diminish the moral distress that is a common response to aggressive care at end-of-life. (shrink)

Background: Moral distress is a common problem among professionals working in the field of healthcare. Moral distress is the distress experienced by a professional when he or she cannot fulfill the correct action due to several obstacles, although he or she is aware of what it is. The level of moral distress experienced by nurses working in intensive care units varies from one country/culture/institution to another. However, in Turkey, there is neither a measurement tool used to (...) assess moral distress suffered by nurses nor a study conducted on the issue. Aim/objective: The study aims to (a) validate the Turkish version of the Moral Distress Scale–Revised to be used in intensive care units and to examine the validity and reliability of the Turkish version of the scale, and (b) explore Turkish intensive care nurses’ moral distress level. Method: The sample of this methodological, descriptive, and cross-sectional design study comprises 200 nurses working in the intensive care units of internal medicine and surgical departments of four hospitals in three cities in Turkey. The data were collected with the Socio-Demographic Characteristics Form and The Turkish Version of Moral Distress Scale–Revised. Ethical considerations: The study proposal was approved by the ethics committee of the Faculty of Medicine, Cumhuriyet University. All participating nurses provided informed consent and were assured of data confidentiality. Results: In parallel with the original scale, Turkish version of Moral Distress Scale–Revised consists of 21 items, and shows a one-factor structure. It was determined that the moral distress total and item mean scores of the nurses participating in the study were 70.81 ± 48.23 and 3.36 ± 4.50, respectively. Conclusion: Turkish version of Moral Distress Scale–Revised can be used as a reliable and valid measurement tool for the evaluation of moral distress experienced by nurses working in intensive care units in Turkey. In line with our findings, it can be said that nurses suffered low level of moral distress. However, factors which caused the nurses in our study to experience higher levels of moral distress are inadequate communication within the team, working with professionals they considered as incompetent, and futile care. (shrink)

In this article we address the social value of bioethics research and show how a participatory approach can achieve social impact for a wide audience of stakeholders, involving them in a process of joint moral learning. Participatory bioethics recognizes that research co-produced with stakeholders is more likely to have impact on healthcare practice. These approaches aim to engage multiple stakeholders and interested partners throughout the whole research process, including the framing of ideas and research questions, so that outcomes (...) are tailored to the interests and context, and the type of impact stakeholders envisage. There is an emphasis on realizing social change through the conduct of the research, and it is believed that the engagement of stakeholders in the research process will promote their intrinsic motivation to change their practice. Another distinctive feature of participatory bioethics research is that its central normative commitment is to reflection and dialogue, not to a particular substantive ethical approach. In reflection and dialogue there is an emphasis on inclusion and the co-production of knowledge. Furthermore, empirical and normative research are combined, and there is a deliberate attempt to give voice to otherwise marginalized positions. This provides a model of social impact which is relevant not only for bioethics research, but also for other areas of health care research. We will show the merits of a participatory approach to bioethics research with a case example. It concerns the reduction of coercion and in particular seclusion in Dutch mental healthcare. (shrink)