FOSTER J, CHIANG F, HILLARD RC, HALL P and HEATH A. Nursing Inquiry 2010; 17: 309–316 Team process in community‐based participatory research on maternity care in the Dominican RepublicA cross‐cultural team consisting of US trained academic midwife researchers, Dominican nurses, and Dominican community leaders have partnered in this international nursing and midwifery community‐based participatory research (CBPR) project in the Dominican Republic to understand the community experience with publicly funded maternity services. The purpose of the study was to (...) understand community perceptions of maternity services. This article highlights the activities that the research team carried out during each phase of the research process, and how they established team identity, team trust, and team efficacy. This research has created a platform for new avenues for health providers and community to partner to improve maternal‐newborn care. Community‐based participatory research is one way forward to address the past and present inequities constitutive of global health disparities. (shrink)

Reconstructive allografts using Vascularized Composite Allotransplantation are providing individuals living with upper limb loss and facial disfigurement with new opportunities for a sensate, esthetically acceptable, and functional alternative to current treatment strategies. Important research attention is being paid to how best to assess and screen candidates for VCA, measure optimal patient outcomes, and support patient adherence to lifelong behaviors and medical regimens. Far less attention, however, has been dedicated to the team science required for these complex VCA teams to (...) form, prepare, and provide the highest quality clinical and psychosocial care to those receiving VCA. VCA teams are unique in that they require specialized team members whose scope of practice may not otherwise overlap. The team also needs to constantly negotiate balancing patient safety with multiple risks throughout the transplant process. This study aimed to elucidate the team science needed for this highly innovative and complex area of medicine. Using in-depth qualitative interviews with 14 VCA team members and observations at team meetings, we found that careful consideration of team composition, team structure, and organizational commitment influences team performance and patient outcomes, but that to be efficient and truly effective, teams need to commit to developing processes that foster collaboration. These processes are action-oriented, strategic and interpersonal. Dedication and commitment to team science allows teams to manage conflict under stress and exercise ways to leverage strengths to provide optimal performance or patient psychosocial and clinical outcomes. This study can provide insight into quality improvement efforts for VCA teams and guidance for other transplant programs that wish to consider expansion into VCA. (shrink)

Judo is a multifactorial sport where many variables or key performance indicators such as force-velocity profile, bioenergetic capacity, technical and tactical skills, and cognitive and emotional competence play a role and influence the final result. While there have been many academic studies of these variables, usually in isolation, none have examined KPIs holistically or analyzed their impact on strategic performance. The main objective of the present study, therefore, is to apply a novel and easily replicable methodology to identify and prioritize (...) the main KPIs affecting performance in professional judo. Such a methodology was applied to the High-Performance Judo Centre of Valencia, using a multi-criteria decision aid technique: the analytic network process. The ANP is used to identify and quantify cause and effect relationships not only between KPIs but also between KPIs and performance objectives. Further, the ANP offers effective results when there is a lack of historical KPI data, because it is based on experts' opinions and judgments. A judo expert group comprising elite judo coaches and half-lightweight male judokas applied the methodology to discriminate between the characteristics required when aiming to reach high-level strategic objectives. The JEG, which consisted of five elite judokas, national and international champions, and three Olympic coaches—including a former European champion and silver medalist in a world championship—provided high added value to the study. The main findings were that the KPIs that made the most difference were mostly psychological, specifically motivation, stress, and team cohesion. Of these, motivation was by far the most important KPI for success in our case study, so judokas should make sure that they analyze it properly. Motivation is usually intrinsic to the competitor and should be maintained at a high level, not only during tournaments but also during daily training and lifestyle activities. Physical and other specific forms of training, as well as lifestyle KPIs, are very important for the elite competitor but are not sufficient to reach high-level objectives. The most important of these KPIs were Kumi-Kata, dual career, focus and concentration level, scouting, nutrition, and basic technique. Power and strength were the most important physical KPIs. In general, these are essential for meeting strategic objectives, but they do not make the crucial difference. This suggests that professional psychological support should be provided in daily training and that international team composition and internships should be fostered. (shrink)

BackgroundHuman failure and a lack of effective communication are the main reasons for preventable adverse events, compromising patient safety in obstetrics. In order to improve safety, team and communication interventions have been implemented but lack feasibility in obstetric care. Psychological models such as the health action process approach might help to improve interventions.MethodsIn a cross-sectional online survey with N = 129 healthcare workers and a paper-pencil survey with N = 137 obstetric healthcare workers at two obstetric university hospitals, (...) associations of social-cognitive variables were tested in a path analysis and a multiple regression. Preliminary results informed a communication training for all obstetric healthcare workers. A repeated-measures MANOVA was used to compare pre- and post-intervention data.ResultsSocial-cognitive variables were associated according to model suggestions except for planning in the first study. Triggers of adverse events were associated with communication behavior, action self-efficacy and planning, as well as barriers to effective communication. The intervention was rated positively. Afterward, fewer triggers were reported and coping self-efficacy increased. There were group differences regarding hospital, experience, and time.DiscussionThe health action process approach was examined in the context of safe communication in obstetrics and can be used to inform interventions. A theory-based, short training was feasible and acceptable. Perceived patient safety improved but communication behavior did not. Future research should aim to test a more comprehensive psychological communication intervention in a thorough RCT design. (shrink)

Management of effort is one of the biggest challenges in any team, and is particularly difficult in distributed teams, where behavior is relatively invisible to teammates. Awareness systems, which provide real-time visual feedback about team members’ behavior, may serve as an effective intervention tool for mitigating various sources of process-loss in teams, including team effort. However, most of the research on visualization tools has been focusing on team communication and learning, and their impact on (...) class='Hi'>team effort and consequently team performance has been hardly studied. Furthermore, this line of research has rarely addressed the way visualization tool may interact with team composition, while comprehension of this interaction may facilitate a conceptualization of more effective interventions. In this article we review the research on feedback in distributed teams and integrate it with the research on awareness systems. Focusing on team effort, we examine the effect of an effort visualization tool on team performance in 72 geographically distributed virtual project teams. In addition, we test the moderating effect of team composition, specifically team members’ conscientiousness, on the effectiveness of the effort visualization tool. Our findings demonstrate that the effort visualization tool increases team effort and improves the performance in teams with a low proportion of highly conscientious members, but not in teams with a high proportion of highly conscientious members. We discuss the theoretical and practical implications of our findings, and suggest the need of future research to address the way technological advances may contribute to management and research of team processes. (shrink)

In this paper, we argue that to reverse the excess of specialization and to create room for interdisciplinary cross-fertilization, it seems necessary to move the existing epistemic plurality towards a collaborative process of social cognition. In order to achieve this, we propose to extend the psychological notion of joint attention towards what we call joint intellectual attention. This special kind of joint attention involves a shared awareness of sharing the cognitive process of knowledge. We claim that if an (...) interdisciplinary research team aspires to work collaboratively, it is essential for the researchers to jointly focus their attention towards a common object and establish a second-person relatedness among them. We consider some of the intellectual dispositions or virtues fostered by joint intellectual attention that facilitate interdisciplinary exchange, and explore some of the practical consequences of this cognitive approach to interdisciplinarity for education and research. (shrink)

The present study specifically focuses on science teachers’ views about scientific inquiry and their use of scientific inquiry in their lesson plans, which were prepared at a professional development workshop designed for better utilization of science centers (SCs). As an impact evaluation research, qualitative data was collected from 41 purposively selected volunteer science teachers. The project team provided the participants with intense instruction in inquiry, and fostered them to learn nature of science and nature of scientific inquiry explicitly. The (...) participants designed lesson plans that integrate school science curricula with exhibits at SCs before and after the workshop. An open-ended questionnaire about the views about scientific inquiry (VASI) was administered before and after the workshop, and teachers’ post-lesson plans were analyzed to detect the presence of scientific inquiry aspects. The majority of teachers exhibited improved views about scientific inquiry based on the VASI instrument. Also, lesson plan analyses indicated that teachers, who showed more improvement in VASI, included more scientific inquiry (SI) elements in their post-lesson plans. It was observed that science teachers’ lesson plans are limited in terms of teaching science in line with real scientific inquiries in SCs to make students learn about the nature of scientific inquiry while learning science. Only two groups embedded SI properly in the SC-oriented lesson plans, and teachers rather used inquiry-based methods of teaching (e.g., argumentation, predict-observe-explain) and process skills (e.g., questioning, explanations). Accordingly, further studies are suggested to develop a specific pedagogical content knowledge framework for teaching with/in SCs. (shrink)

Collective intelligence in organizational teams has been predominantly understood and explained in terms of the quality of the outcomes that the team produces. This manuscript aims to extend the understanding of CI in teams, by disentangling the core of actual collective intelligent team behavior that unfolds over time during a collaboration period. We posit that outcomes do support the presence of CI, but that collective intelligence itself resides in the interaction processes within the team. Teams behave collectively (...) intelligent when the collective behaviors during the collaboration period are in line with the requirements of the tasks the team is assigned to and the environment. This perspective results in a challenging, but promising research agenda armed with new research questions that call for unraveling longitudinal fine-grained interactional processes over time. We conclude with exploring methodological considerations that assist researchers to align concept and methodology. In sum, this manuscript proposes a more direct, thorough, and nuanced understanding of collective intelligence in teams, by disentangling micro-level team behaviors over the course of a collaboration period. With this in mind, the field of CI will get a more fine-grained understanding of what really happens at what point in time: when teams behave more or less intelligently. Additionally, when we understand collectively intelligent processes in teams, we can organize targeted interventions to improve or maintain collective intelligence in teams. (shrink)

Multiple theories of problem-solving hypothesize that there are distinct qualitative phases exhibited during effective problem-solving. However, limited research has attempted to identify when transitions between phases occur. We integrate theory on collaborative problem-solving with dynamical systems theory suggesting that when a system is undergoing a phase transition it should exhibit a peak in entropy and that entropy levels should also relate to team performance. Communications from 40 teams that collaborated on a complex problem were coded for occurrence of problem-solving (...) processes. We applied a sliding window entropy technique to each team's communications and specified criteria for identifying data points that qualify as peaks and determining which peaks were robust. We used multilevel modeling, and provide a qualitative example, to evaluate whether phases exhibit distinct distributions of communication processes. We also tested whether there was a relationship between entropy values at transition points and CPS performance. We found that a proportion of entropy peaks was robust and that the relative occurrence of communication codes varied significantly across phases. Peaks in entropy thus corresponded to qualitative shifts in teams’ CPS communications, providing empirical evidence that teams exhibit phase transitions during CPS. Also, lower average levels of entropy at the phase transition points predicted better CPS performance. We specify future directions to improve understanding of phase transitions during CPS, and collaborative cognition, more broadly. (shrink)

A growing body of research reveals that abusive supervision may have negative impacts in organizations. The purpose of the present study is to expand the knowledge regarding the impacts of this dysfunctional leadership behavior by examining its relationship with innovation in work teams. Specifically, we investigate the process through which abusive supervision may undermine team innovation by taking into account the mediating role of team proactive behavior. Moreover, we propose a boundary condition of the negative effect of (...) abusive supervision by considering leader–members interdependence as a moderator. Using a multisource approach, data were gathered from 394 members and 82 immediate supervisors in a public safety organization. Results of path analyses reveal that the relationship between abusive supervision and team innovation is mediated by team proactive behavior. Furthermore, we found that the relationship between abusive supervision and team proactive behavior is moderated by leader–members interdependence, such that this relationship is stronger when the level of interdependence is high. Taken together, the findings of this study improve the understanding of why and under what circumstances abusive supervision may impair team innovation. (shrink)

Teams are a fundamental aspect of life—from sports to business, to defense, to science, to education. While the cognitive sciences tend to focus on information processing within individuals, others have argued that teams are also capable of demonstrating cognitive capacities similar to humans, such as skill acquisition and forgetting (cf., Cooke, Gorman, Myers, & Duran, 2013; Fiore et al., 2010). As artificially intelligent and autonomous systems improve in their ability to learn, reason, interact, and coordinate with human teammates combined with (...) the observation that teams can express cognitive capacities typically seen in individuals, a cognitive science of teams is emerging. Consequently, new questions are being asked about teams regarding teamness, trust, the introduction and effects of autonomous systems on teams, and how best to measure team behavior and phenomena. In this topic, four facets of human-autonomy team cognition are introduced with leaders in the field providing in-depth articles associated with one or more of the facets: (1) defining teams; (2) how trust is established, maintained, and repaired when broken; (3) autonomous systems operating as teammates; and (4) metrics for evaluating team cognition across communication, coordination, and performance. (shrink)

Competitive athletes act within cultures of risk in sports and often decide to return to sport despite having acute health problems. The outcomes of such risky return-to-play decisions can not only negatively affect their future health, but also limit their sports performance or even upset their career paths. Following risk-management-decision theory with its focus on active risk defusing, we developed a model for understanding the process of return-to-play decision making from an athlete’s perspective. Based on the method of active (...) information search, a quasi-naturalistic return-to-play decision scenario was created in order to assess amateur team sport athletes’ decision making strategies. The main goals were to identify different information acquisition patterns and to analyze the influence of social pressure to play hurt on decision making. A total of 72 competitive team sport athletes (36 females, 36 males, m= 25.7 years of age, 3rd to 6th league level) out of three disciplines (volleyball, basketball, and handball) participated in the experimental study. Facing the same medical scenario (a partial tear of the supraspinatus tendon), athletes show different approaches to return-to-play decision making. The main focus is on potential sporting consequences of withdrawal from competition due to injury, while only few players favoring well-informed decisions based on thorough risk analysis. The athletes who chose the medically risky alternative to play hurt mostly employed strategies of active risk defusing, which got activated when severe sporting consequences were perceived. Those who chose to withdraw from competition primarily referred to maximin heuristic, particularly when social pressure to play was reduced. The findings can be used to improve rehabilitation. (shrink)

In Brazil, every study involving human beings is required to produce an informed consent form that must be signed by study participants: this is stated in Resolution 196/96. 1 Consent must be obtained through a specific structured process. Objective: To present the opinions of women regarding how the process of obtaining informed consent should be conducted when women are invited to participate in studies on contraceptive methods. Subjects and Methods: Eight focus groups were conducted, involving a total of (...) 51 women living in the metropolitan region of Campinas. The women involved in the study were either participating in a clinical trial in the area of women's health or had participated in such a trial in the previous 12 months. A thematic guide was used to conduct the focus group discussions; the discussions were recorded, transcribed and a thematic analysis performed. Results: In general, the person who invites a woman to participate in a study should be a member of the research team but not the principal investigator. Information relating to the study should be given orally and in writing, both individually and in the group setting. Study volunteers should be informed about, among other things, the risks, possible side effects and discomforts, including long-term effects. The use of audiovisual aids to provide information was suggested. Conclusion: The process for obtaining informed consent was seen as a means of establishing a relationship between the volunteers and the investigator/research team. The information that the study participants expected to be given coincides with the requirements established under Resolution 196/96. The use of audiovisual aids would improve understanding of the information provided. (shrink)

The survival and success of organizations increasingly depend on creativity. A Supervisor Creative Feedback Environment is of special value in enhancing team creativity, but few studies have explored the relationship between the supervisor creative feedback environment and creativity and how it affects creativity. Based on feedback intervention theory and triadic reciprocal determinism, this paper explores the process mechanism and boundary conditions of the supervisor creative feedback environment affecting team creativity from the perspectives of ambidextrous learning and (...) class='Hi'>team creative cognitive style. With 506 team members from 115 work teams in domestic enterprises as research samples, regression analysis was used to test the theoretical hypotheses. Feedback intervention, according to the feedback intervention theory, is a complicated process. There are various influencing factors, such as the feedback provider, means of feedback intervention, the content of the feedback information, situational factors, and the feedback recipients. The leading creative feedback loop includes important feedback receiver's factors which are not mentioned above. Triadic reciprocal determinism holds that individual behavior is formed by the interaction and interconnection of individual, environment, and behavior. The two above-mentioned theories can explain why the leadership creative feedback environment can affect team creativity by influencing ambidextrous learning. The results also show that the feedback environment of supervisor creativity has positive effects on team creativity. Ambidextrous learning mediates the relation between supervisor creative feedback environments and team creativity. Team creative cognitive style has a positive moderating effect on the indirect relationship between a supervisor creative feedback environment and team creativity through ambidextrous learning. This study validates feedback intervention theory and triadic reciprocal determinism, expands the application of feedback environment factors in the research field of team creativity, provides a theoretical framework for the influence of the creative feedback environment on team creativity, and also provides theoretical support for managers to apply the management tool of a supervisor creative feedback environment to organizational context to improve team creativity. Based on the research results, this paper puts forward corresponding management suggestions from the aspect of creating a supervisor creative feedback environment, attaching importance to team ambidextrous learning, and making good use of creative cognitive style. (shrink)

Over the past 3 years, the authors have pursued unique cross-college collaboration. They have hosted a National Endowment for the Humanities (NEH)–funded Humanities Gaming Institute and team-taught a cross-listed course that brought together students from the humanities and computer science. Currently, they are overseeing the development of an NEH-supported social history game called Desperate Fishwives. In the process, the authors have realized that “game” is not the most appropriate designator for the kind of projects they are pursuing. Instead, (...) they propose critical interactives, a term that suggests projects that mobilize ludic methods in order to engage participants in socially and politically sensitive, indeed controversial, subject matter. Their most recent project, Ghosts of the Horseshoe, offers an initial look at how critical interactives are particularly apt at raising awareness about the relations among institutional policy, broader public policy, and the ways that people negotiate the public history of a particular place. (shrink)

Obtaining a sufficient amount of measurable and reliable results of student surveys has always posed a challenge for university teams tasked with the provision of the quality of education. This is especially visible at faculties where education is based on the classic classroom-based model, which then transfers to clinical units, hospital wards, and specialist laboratories. The highly unpredictable pandemic situation caused by the SARS-CoV-2 virus raises the bar for the evaluation of didactics. Fortunately, the continuous technological progress in the area (...) of Artificial Intelligence makes it possible to design the implementation of tools that would improve the position of systems for the management of courses of studies. The evaluation survey for didactic classes, as one of the last output data obtained during the process, may finally become a fully recognized source of information about the conducted classes and the teachers themselves. On the other hand, it may become a tool for those surveyed to influence the quality of classes, express their opinion, present suggestions and propositions generally pertaining to changes in the process of education. New information technologies not only make it possible to improve the effectiveness of reaching the recipients, but also provide completely new, very reliable methods of acquisition of credible behaviour, used as integration data in solutions based on machine communication. Using Artificial Intelligence coupled with data may make it possible to use intelligent communication for effective management of the process of surveying – a solution that has so far been used in business, in the form of the so-called bots. As a result, this would lead to an ongoing, fully quantitative and qualitative, assessment of classes. (shrink)

From a cognitive-psychological perspective, physical exercise (PE) and sports are an interesting tool for improving people’s cognitive abilities. One field of application for such a tool is decision making (DM) support in chronic patients, cancer patients, and survivors in particular. On the one hand, cancer patients and survivors have to continually take important decisions about their own care (e.g., treatment choice; changes in lifestyle), in collaboration with caregivers and health providers; on the other hand, side effects of treatment may be (...) detrimental to cognitive abilities, such as attention, which make the health DM tasks even more demanding, complex, and emotionally disruptive for patients. Since cancer patients have to engage in healthy activities both for improving their own quality of life and for sustaining the effects of medications, clinical advice to engage in sport and PE is becoming more and more widespread within interventions. However, while sports are usually seen as healthy physical activities, their impact on cognitive abilities is mostly overlooked in the literature. The hypothesis of the present work is that sports could be fully exploited in their potential as focused exercises for cognitive ability training, in the field of cognitive training for chronic patients specifically. Indeed, literature shows that different sports (e.g., individual or team-based) influence and possibly augment cognitive abilities such as focused and divided attention, working memory, and DM under time constraints. Moreover, besides providing training for cognitive abilities, the experience of sports may represent an opportunity to explore, train and sharpen DM abilities directly: we identify five ways in which sport experiences may influence DM processes, and provide indications for future research on the topic. (shrink)

Performance Generating Systems (PGS) are rule- and task-based approaches to improvisation on stage in theatre, dance, and music. These systems require performers to draw on predefined source materials (texts, scores, memories) while working on complex tasks within limiting rules. An interdisciplinary research team at a large Western Canadian university hypothesized that learning to sustain this praxis over the duration of a performance places high demands on executive functions; demands that may improve the performers’ executive abilities. These performers need to (...) continuously shift attention while remaining responsive to embodied and environmental stimuli in the present, they are required to inhibit automated responses and impulses using the rules of the system, and they strive towards addressing multitasking challenges with fluidity and flexibility. This study set out to test the mentioned hypothesis deductively and identify mediating processes inductively, using mixed empirical methods. In a small sample experiment with a control group (28 participants; 15 in intervention group, 13 in control group), standardized quantitative tests of executive functions (D-KEFS) were administered before and after an eight-week intervention. Participant-reported qualitative observations from the praxis were also collected throughout the intervention for grounded analysis. Within the limitations of small sample data, we found both statistically significant and trending effects on inhibition, problem-solving initiation, fluidity, and cognitive flexibility. Examining the mediating process, we found that participants experienced significant challenges sustaining the practice halfway through the intervention. The participant-reported solutions to these challenges, which emerged as the strongest behavioural patterns when coding the qualitative data to saturation, were strategies of problem-solving and of re-directing attention. These strategies support and advance our understanding of the effects measured in the standardized tests. In terms of application, our results identify characteristics of PGS that could potentially maintain and strengthen executive functions over and above less demanding performing arts interventions. The results also deliver new insight into how PGS works, which may contribute to the development and teaching of this artistic practice. (shrink)

A vast stream of empirical work has revealed that coach and athlete leadership are important determinants of sport teams’ functioning and performance. Although coaches have a direct impact on individual and team outcomes, they should also strive to stimulate athletes to take up leadership roles in a qualitative manner. Yet, the relation between coach leadership behavior and the extent of high-quality athlete leadership within teams remains underexposed. Based on organizational justice theory and the social identity approach, the present research (...) tested whether perceived justice of the coach positively predicts the quality of athlete leadership. Furthermore, we examined the role of group dynamic processes within this relation. Belgian volleyball and basketball players were asked to rate the justice of their coach, their team identification, the task cohesion, and the athlete leadership quality in the team. Structural equation modeling indicated that coaches’ perceived justice positively predicted the quality of athletes’ leadership, and that this relation was established through three intermediate steps. These results suggest that fair coach behavior does not only bridge the gap between leadership and followership, it also has the potential to improve the quality of athletes’ leadership within sport teams. More specifically, findings suggest that coaches’ perceived justice cultivates a shared social identity characterized by high levels of players’ identification with their team, which in turn increased their perceptions of the team’s task cohesion. Finally, this increased task cohesion encouraged the athlete leaders to demonstrate high-quality leadership. (shrink)

Individuals with a balanced time perspective, which includes good thoughts about the past, awareness of present constraints and adaptive planning for a positive future, are more likely to report optimal wellbeing. However, people who have had traumas such as adverse childhood experiences (ACEs) are likely to have less balanced time perspectives and lower overall wellbeing when compared to those with fewer or no ACEs. Time perspective can be improved viatime-travel narrativesthat support people in feeling connected to a wise and loving (...) future version of themselves, an approach that has until now only been provided in counseling contexts. Our team used an iterative inclusive design process to shape a scalable time-travel narrative tool – a responsive and progressive web application calledTime Machine.Among other functionalities, Time Machine allowed people to record and listen to messages as if they were from and to their past and future selves. Using pre-planned as well aspost-hocanalyses, we analyzed quantitative and qualitative data from 96 paid design partners (participants) who were taken through a 26-day pilot study of the technology. Among other effects, the results revealed: (1) high engagement throughout the design process, (2) improvements in self-reported time perspective and overall wellbeing scores that were greater for those using Time Machine during an optional-use period, (3) twice as much improvement in overall wellbeing scores for design partners with high ACEs (16%) versus low ACEs (8%), and (4) feelings of unconditional love apparently mediating the relationship between scores on time perspective and overall wellbeing measures. We discuss the limitations of these results as well as implications for the future role of spiritually informed scalable time-travel narrative technologies in healthcare and wellness. (shrink)

Despite the prevalence of beliefs across religions regarding repentance and divine forgiveness and their recognition in theoretical and religious studies, these constructs are relatively understudied phenomena in the social sciences. Furthermore, in recent years, multiple scholars have argued for the need for research to systematically study and highlight the experience and processes of repentance and divine forgiveness. Subsequently, this study explored processes of repentance, antecedents and motivations of repentance, resources to aid in repentance, and outcomes of repentance that should be (...) further examined. This analysis was done using in-depth qualitative interviews with 15 emerging adult religious exemplars identifying with the Church of Jesus Christ of Latter-day Saints. The authors used NVivo 12 and team-based qualitative coding processes to identify themes. Repentance processes included personal change, took various lengths of time, were a part of participants’ religious identity, were recurrent processes, and were influenced by participants’ view of God. Antecedents and motivations included religious practices and rituals, emotions, interpersonal interactions, and their relationship with God. Resources that aided in repentance included religious practices and rituals, interpersonal relationships, and a relationship with God. Finally, participants reported experiencing personal changes in their behavior and character, positive emotions (including feelings of divine forgiveness), improved interpersonal relationships, and a better relationship with God. These processes align with some previously discovered and theorized findings on repentance, contribute a number of novel findings, and offer future direction regarding the motivations, resources, and transformative experiences that participants reported in their personal repentance and experience of forgiveness. (shrink)

In order to make strategic decisions and improve their firm’s performance, top management teams must have information on the competitive context in general, and the firm’s competitors in particular. During the decision-making process, top managers can have access to “privileged information”—i.e., information of a confidential and potentially strategic nature that could ultimately confer a decisional advantage over competing parties. However, obtaining and using privileged information in a business context is often illegal—and if not, is usually deemed unethical or “against (...) the rules.” Using a quasi-experimental design, this study explores the reasons why an individual might engage in such unethical behavior. We assess the extent to which managers use privileged information with respect to perceived team cohesion and peers’ ethicality. More specifically, our results show that the use of privileged information is predicted by the decision-maker’s perceptions of their team cohesion and their peers’ ethicality. Moreover, we find that team performance, as a group-level nonself-reported factor, moderates the relationship between cohesion and the use of privileged information. The relationship between cohesion, ethical behavior, and team performance is also discussed. We draw on these findings to make some practical suggestions on how to incorporate practices that could better prevent the unethical use of privileged information in strategic decision-making processes. (shrink)

Cultural Consultation is a clinical process that emerged from anthropological critiques of mental healthcare. It includes attention to therapeutic communication, research observations and research methods that capture cultural practices and narratives in mental healthcare. This essay describes the work of a Cultural Consultation Service (ToCCS) that improves service user outcomes by offering cultural consultation to mental health practitioners. The setting is a psychiatric service with complex and challenging work located in an ethnically diverse inner city urban area. Following a (...) period of 18 months of cultural consultation, we gather the dominant narratives that emerged during our evaluation of our service. Results: These narratives highlight how culture is conceptualized and acted upon in the day-to-day practices of individual health and social care professionals, specialist psychiatric teams and in care systems. The findings reveal common narratives and themes about culture, ethnicity, race and their perceived place and meaningfulness in clinical care. These narratives express underlying assumptions and covert rules for managing, and sometimes negating, dilemmas and difficulties when considering “culture” in the presentation and expression of mental distress. The narratives reveal an overall “culture of understanding cultural issues” and specific “cultures of care”. These emerged as necessary foci of intervention to improve service user outcomes. Conclusion: Understanding the cultures of care showed that clinical and managerial over-structuring of care prioritises organisational proficiency, but it leads to inflexibility. Consequently, the care provided is less personalised and less accommodating of cultural issues, therefore, professionals are unable to see or consider cultural influences in recovery. (shrink)

Healthcare ethics consultants in the Veterans Health Administration (VHA) document consults in an enterprise-wide web-based database entitled IEWeb, serving as a system of record for healthcare ethics documentation at 1300 VA facilities. The need arose to evolve the database from an ethics process training resource into a more streamlined documentation repository that captures essential consult elements. A VHA National Center for Ethics in Health Care (NCEHC) Improvement Team convened for three tasks: (1) Specify and prioritize IEWeb changes (...) (occurred via six focus groups composed of “new user” and “super user” cohorts with analysis of existing documentation patterns); (2) Pilot the changes regionally (via regional communication, training, and reviews of pre-post use patterns); and (3) Measure the impact of national change implementation on user perspectives (via pre-and post-change implementation polls). Focus groups identified six implementable priority areas for ethics consult documentation improvement, including the development of a usable consult summary note for ready conversion from IEWeb fields into the electronic health record. Post-IEWeb updates showed an increased number of consults documented, a reduction in “time to consult documentation closure” by a mean of 4.5 days, and a clinically-meaningful improvement in the quality of documentation (78% of ethics questions scored “above-bar” on the validation tool pre- vs. 89% scored “above-bar” post-IEWeb changes, n = 140). According to national survey findings, the number of consultants documenting “all” consults in IEWeb increased, satisfaction increased, and perception of documentation difficulty decreased. IEWeb simplification enabled ethics consultants to re-focus their documentation completion efforts by decreasing perception of documentation burden while improving documentation frequency and quality in a clinically-meaningful way. (shrink)

Many of the humanistic values that CSR3 theorists would like to see embedded in business organizations are the foundation of participatory management theory. Does the institutionalization of democratic processes and values-in the form of nonmanagement employees voicing their opinions on production issues and electing representatives to key decision-making teams-improve a company's social performance? This research question is examined based on the documentation of changes in stakeholder policies and outcomes at four companies operating under a Scanlon-type gainsharing system for 4 to (...) 6 years. Gainsharing's collaborative problem-solving mechanisms benefited owners in terms of cost savings, customers in terms of improved product quality and service, suppliers in terms of product feedback, and production employees in terms of improved health and safety conditions, as well as a variety of other favorable changes in policies and outcomes. (shrink)

This paper offers a narrative approach to understanding the process of clinical reasoning in complex cases involving medical uncertainty, moral ambiguity, and futility. We describe a clinical encounter in which the pediatric health care team experienced a great deal of conflict and distrust as a result of an ineffective process of interpretation and communication. We propose a systematic method for analyzing the technical, ethical, behavioral, and existential dimensions of the clinical reasoning process, and introduce the Clinical (...) Reasoning Discussion Tool—a dialogical and interpretive device aimed at improving communication, understanding, empathy, and moral deliberation in the clinical setting. (shrink)

BackgroundClinical Ethics Support (CES) services are offered to support healthcare professionals in dealing with ethically difficult situations. Evaluation of CES is important to understand if it is indeed a supportive service in order to inform and improve future implementation of CES. Yet, methods to measure outcomes of CES are scarce. In 2014, the European Moral Case Deliberation Outcomes Instrument (Euro-MCD) was developed to measure outcomes of Moral Case Deliberation (MCD). To further validate the instrument, we tested it in field studies (...) and revised it. This paper presents the Euro-MCD 2.0 and describes the revision process.MethodsThe revision process comprised an iterative dialogue among the authors as Euro-MCD-project team, including empirical findings from six Euro-MCD field-studies and input from European experts in CES and theory. Empirical findings contained perceptions and experiences of MCD outcomes among healthcare professionals who participated in MCDs in various settings in Norway, Sweden and the Netherlands. Theoretical viewpoints on CES, literature on goals of CES and MCD and ethics theory guided the interpretation of the empirical findings and final selection of MCD outcomes.ResultsThe Euro-MCD 2.0 Instrument includes three domains: Moral Competence, Moral Teamwork and Moral Action. Moral Competence consists of items about moral sensitivity, analytical skills and virtuous attitude. Moral Teamwork includes open dialogue and supportive relationships and Moral Action refers to moral decision-making and responsible care. During the revision process, we made decisions about adding and reformulating items as well as decreasing the number from 26 to 15 items. We also altered the sentence structure of items to assess the current status of outcomes (e.g. ‘now’) instead of an assumed improvement over time (e.g. ‘better’) and we omitted the question about perceived importance.ConclusionsThe Euro-MCD 2.0 is shorter, less complex and more strongly substantiated by an integration of empirical findings, theoretical reflections and dialogues with participants and experts. Use of the Euro-MCD 2.0 will facilitate evaluation of MCD and can thereby monitor and foster implementation and quality of MCD. The Euro-MCD 2.0 will strengthen future research on evaluation of outcomes of MCD. (shrink)

This article reports the findings of a qualitative study that explored the organizational influences on moral distress for health professionals working in pediatric intensive care units across Canada. Participants were recruited to the study from PICUs across Canada. The PICU is a high-tech, fast-paced, high-pressure environment where caregivers frequently face conflict and ethical tension in the care of critically ill children. A number of themes including relationships with management, organizational structure and processes, workload and resources, and team dynamics were (...) identified. This study provides a rare and important multi-disciplinary perspective on this topic and the findings have implications for administrators and leaders who seek to improve the moral climate of healthcare delivery. (shrink)

In team-based tasks, successful communication and mutual understanding are essential to facilitate team coordination and performance. It is well-established that an important component of human conversation is the maintenance of common ground. Maintaining common ground has a number of associated processes in which conversational participants engage. Many of these processes are lacking in current synthetic teammates, and it is unknown to what extent this lack of capabilities affects their ability to contribute during team-based tasks. We focused our (...) research on how teams package information within a conversation, by which we mean specifically whether information is explicitly mentioned or implied, and how multiple pieces of information are ordered both within single communications and across multiple communications. We re-analyzed data collected from a simulated remotely-piloted aerial system task in which team members had to specify speed, altitude, and radius restrictions. The data came from three experiments: the “speech” experiment, the “text” experiment, and the “evaluation” experiment. We asked first whether teams settled on a specific routine for communicating the speed, altitude, and radius restrictions, and whether this process was different if the teams communicated in speech compared to text. We then asked how receiving special communication instructions in the evaluation experiment impacted the way the human teammates package information. We found that teams communicating in either speech or text tended to use a particular order for mentioning the speed, altitude, and radius. Different teams also chose different orders from one another. The teams in the evaluation experiment, however, showed unnaturally little variability in their information ordering and were also more likely to explicitly mention all restrictions even when they did not apply. Teams in the speech and text experiments were more likely to leave unnecessary restrictions unmentioned, and were also more likely to convey the restrictions across multiple communications. The option to converge on different packaging routines may have contributed to improved performance in the text experiment compared some of the conditions in the evaluation experiment. (shrink)

Leadership plays an essential part in creating competitive advantage and well-being among employees. One way in which formal leaders can deal with the variety of responsibilities that comes with their role is to share their responsibilities with team members (i.e., shared leadership). Although there is abundant literature on how high-quality peer leadership benefits team effectiveness (TE) and well-being, there is only limited evidence about the underpinning mechanisms of these relationships and how the formal leader can support this (...) class='Hi'>process. To address this lacuna, we conducted an online survey study with 146 employees from various organizations. The results suggest that an empowering leadership style of the formal leader is associated with higher perceived peer leadership quality (PLQ) on four different leadership roles (i.e., task, motivational, social, and external leader). In addition, formal leaders who empower their team members are also perceived as better leaders themselves. Moreover, the improved PLQ was in turn positively related to TE and work satisfaction, while being negatively related to burnout. In line with the social identity approach, we found that team identification mediated these relationships. Thus, high-quality peer leaders succeeded in creating a shared sense of “us” in the team, and this team identification in turn generated all the positive outcomes. To conclude, by sharing their lead and empowering the peer leaders in their team, formal leaders are key drivers of the team’s effectiveness, while also enhancing team members’ health and well-being. (shrink)

Although research on the benefits of problem construction within the creative process is expanding, research on team problem construction is limited. This study investigates the cognitive process of problem construction and identification at the team level through an experimental design. Furthermore, this study explores team social processes in relation to problem construction instructions. Using student teams solving a real-world problem, the results of this study revealed that teams that engaged in problem construction and identification generated (...) more original ideas than teams that did not engage in such processes. Moreover, higher satisfaction and lower conflict was observed among groups that engaged in problem construction compared to groups that did not engage in problem construction. These findings highlight the utility of problem construction for teams engaging in creative problem-solving. (shrink)

Communication in a collaborative problem-solving activity plays a pivotal role in the success of the collaboration in both academia and the workplace. Computer-supported collaboration makes it possible to collect large-scale communication data to investigate the process at a finer granularity. In this paper, we introduce a conditional transition profile (CTP) to characterize aspects of each team member's communication. Based on the data from a large-scale empirical study, we found that participants in the same team tend to show (...) similar CTP compared to participants from different teams. We also found that team members who showed more “negotiation” after the partner “shared” information tended to show more improvement after the collaboration while those who continued sharing ideas while their partners were negotiating tended to improve less. (shrink)

With increasing technological improvements, production processes are becoming more and more automated. Nevertheless, full automation is improbable in the medium term since human abilities cannot yet be completely replaced. Therefore, it is likely that so-called hybrid human–robot teams will assume the future production. This raises questions regarding the shaping of future production and the effects it will have on the employees, workstations, and the companies as a whole. The project “Work in the Industry of the Future” addresses the entirely new (...) cooperative relationship between man and technology in the Industry 4.0 and its impact on opportunities for the work force. To derive the requirements and effects of hybrid workplaces, an initial work analysis of existing workplaces with varying levels of technological enhancement will be conducted. Multiple standardized work analysis instruments that vary in method, duration, level of analysis, and recorded characteristics already exist. This paper gives an overview of an assortment of these methods that can be used in production. (shrink)

The Russian people are struggling to learn how to create a democracy and a market economy. This paper reviews the results of reform efforts to date and what the Russian people are learning as indicated by changes in answers to public opinion surveys. As a way to continue the social learning process in Russia we suggest the widespread use of process improvement methods in organizations. This paper describes some Russian experiences in using process improvement methods (...) and proposes a strategy for spreading the use of these methods through universities and then through businesses and government agencies. As people use process improvement methods, they gain confidence in their ability to improve the functioning of organizations and society. (shrink)

The basis of the economic power of the state is the stability of the existence of each business entity by ensuring their economic security. Today, the successful management of the enterprise for progressive development requires new forms and methods of evaluation team activities, the quality of the results of labor, production checks and social processes, which are expressed often in qualitative characteristics. The method for evaluation process to ensure the economic security of any object of economic activity by (...) qualimetry was introduced in article. Proposed method is based on expert opinion. Determined algorithm for use this method and possible for use. The proposed qualimetric model of evaluation the process to ensure the economic security for object of economic activity, allows determine and quantify shortcomings in the work of the enterprise, detect way to improve process to ensure the economic security of any object of economic activity by adequate amount of management solutions, make conclusion in dynamics of this process, to have a possibility to compare work results of different object of economic activity. The method facilitates the adoption of adequate administrative decisions, with further assessment of objectives achievements. (shrink)

Despite technological innovations, clinical expertise remains the cornerstone of psychiatry. A clinical expert does not only have general textbook knowledge, but is sensitive to what is demanded for the individual patient in a particular situation. A method that can do justice to the subjective and situation-specific nature of clinical expertise is ethnography. Effective deep brain stimulation (DBS) for obsessive-compulsive disorder (OCD) involves an interpretive, evaluative process of optimizing stimulation parameters, which makes it an interesting case to study clinical expertise. (...) The aim of this study is to explore the role of clinical expertise through an ethnography of the particular case of DBS optimization in OCD. In line with the topic of the special issue this article is a part of, we will also use our findings to reflect on ethnography as a method to study complex phenomena like clinical expertise. This ethnography of DBS optimization is based on 18 months of participant observation and nine in-depth interviews with a team of expert clinicians who have been treating over 80 OCD patients since 2005. By repeatedly observing particular situations for an extended period of time, we found that there are recurrent patterns in the ways clinicians interact with patients. These patterns of clinical practice shape the possibilities clinicians have for making sense of DBS-induced changes in patients’ lived experience and behavior. Collective established patterns of clinical practice are dynamic and change under the influence of individual learning experiences in particular situations, opening up new possibilities and challenges. We conclude that patterns of clinical practice and particular situations are mutually constitutive. Ethnography is ideally suited to bring this relation into view thanks to its broad temporal scope and focus on the life-world. Based on our findings, we argue that clinical expertise not only implies skillful engagement with a concrete situation but also with the patterns of clinical practice that shape what is possible in this specific situation. Given this constraining and enabling role of practices, it is important to investigate them in order to find ways to improve diagnostic and therapeutic possibilities. (shrink)

Brain Computer Interface (BCI) technology offers potential for human augmentation in areas ranging from communication to home automation, leisure and gaming. This paper addresses ethical challenges associated with the wider scale deployment of BCI as an assistive technology by documenting issues associated with the development of non-invasive BCI technology. Laboratory testing is normally carried out with volunteers but further testing with subjects, who may be in vulnerable groups is often needed to improve system operation. BCI development is technically complex, sometimes (...) requiring lengthy recording sessions to achieve the necessary personalisation of the paradigms, and this can present ethical challenges that vary depending on the subject group. The paper contributes to the on-going ethical discussion surrounding the deployment BCI outside the specialist laboratory and suggests some tentative guidelines for BCI research teams, appropriate to those deploying the technology, derived from experience on a multisite project. Any tension between deployment and technical progress must be managed by a formal process within a multidisciplinary consortium. (shrink)

BackgroundCommunity engagement within biomedical research is broadly defined as a collaborative relationship between a research team and a group of individuals targeted for research. A Community Advisory Board is one mechanism of engaging the community. Within genomics research CABs may be particularly relevant due to the potential implications of research findings drawn from individual participants on the larger communities they represent. Within such research, CABs seek to meet instrumental goals such as protecting research participants and their community from research-related (...) risks, as well as intrinsic goals such as promoting the respect of participants and their community. However, successful community engagement depends on the degree to which CABs legitimately represent and engage with communities targeted for research. Currently, there is little literature describing the use of CABs in genomics research taking place in developing countries, and even less in the field of genomics research relating to mental illness. The aim of this article is to describe and consider the contributions made by a researcher-driven, population-specific CAB in a genomics of schizophrenia research project taking place in South Africa, from the perspective of the research team.DiscussionFour broad discussion topics emerged during the CAB meetings namely: 1) informed consent procedures, 2) recruitment strategies, 3) patient illness beliefs and stigma experiences, and 4) specific ethical concerns relating to the project. The authors consider these discussions in terms of their contributions to instrumental and intrinsic goals of community engagement.SummaryThe CAB gave valuable input on the consent processes and materials, recruitment strategies and suggested ways of minimizing the potential for stigma and discrimination. All of these contributions were of an instrumental nature, and helped improve the way in which the research took place. In addition, and perhaps more importantly, the CAB made a unique and important contribution relating to intrinsic functions such as promoting the respect and dignity of research participants and their community. This was particularly evident in ensuring sensitivity and respect of the community’s traditional beliefs about schizophrenia and its treatment, and in this way promoting a respectful relationship between the research team and the participants. (shrink)

BackgroundThe U.S. Food and Drug Administration traditionally has kept confidential significant amounts of information relevant to the approval or non-approval of specific drugs, devices, and biologics and about the regulatory status of such medical products in FDA’s pipeline.ObjectiveTo develop practical recommendations for FDA to improve its transparency to the public that FDA could implement by rulemaking or other regulatory processes without further congressional authorization. These recommendations would build on the work of FDA’s Transparency Task Force in 2010.MethodsIn 2016-2017, we convened (...) a team of academic faculty from Harvard Medical School, Brigham and Women’s Hospital, Yale Medical School, Yale Law School, and Johns Hopkins Bloomberg School of Public Health to develop recommendations through an iterative process of reviewing FDA’s practices, considering the legal and policy constraints on FDA in expanding transparency, and obtaining insights from independent observers of FDA.ResultsThe team developed 18 specific recommendations for improving FDA’s transparency to the public. FDA could adopt all these recommendations without further congressional action.FundingThe development of the Blueprint for Transparency at the U.S. Food and Drug Administration was funded by the Laura and John Arnold Foundation. (shrink)

Obtaining informed consent from patients prior to a medical or surgical procedure is a fundamental part of safe and ethical clinical practice. Currently, it is routine for a significant part of the consent process to be delegated to members of the clinical team not performing the procedure (eg, junior doctors). However, it is common for consent-taking delegates to lack sufficient time and clinical knowledge to adequately promote patient autonomy and informed decision-making. Such problems might be addressed in a (...) number of ways. One possible solution to this clinical dilemma is through the use of conversational artificial intelligence using large language models (LLMs). There is considerable interest in the potential benefits of such models in medicine. For delegated procedural consent, LLM could improve patients’ access to the relevant procedural information and therefore enhance informed decision-making.In this paper, we first outline a hypothetical example of delegation of consent to LLMs prior to surgery. We then discuss existing clinical guidelines for consent delegation and some of the ways in which current practice may fail to meet the ethical purposes of informed consent. We outline and discuss the ethical implications of delegating consent to LLMs in medicine concluding that at least in certain clinical situations, the benefits of LLMs potentially far outweigh those of current practices. (shrink)

Ensuring diversity within the healthcare sector is essential for improving team dynamics and ultimately patient outcomes. Diversity among medical students is fundamental to embody this philosophy. With the demand for diversity in the admissions process gaining traction, the authors expanded this conversation to the editorial boards (EBs) of Medical Student Journals (MSJs). The authors designed a cross-sectional study to evaluate the diversity status of EBs of MSJs under gender, geographic, and socioeconomic parameters using the Journal Diversity Index (JDI). (...) Relevant information regarding the journal characteristics and the editorial board members (EBMs) of systematically screened journals was sequentially extracted along with job roles, which were later categorized into eight categories. Chi-squared test was applied to study the association between gender of the editor and the global distribution of the journal. Out of 22 included journals, 90.9% were published by institutions based in high-income countries (HICs). On regional analysis, none of the journals originated from “South Asia,” “Latin America and the Caribbean,” and “Middle East and North Africa”. Disparity in gender representation of EBMs became more prominent in senior roles. Additionally, 78.8% EBMs belonged to HICs. Regional analysis of EBMs revealed 83% belonging to the Global North. This disparity was seen across all editorial job roles. A greater disparity was seen among editors from the Global South with men comprising 66.4% of the total editors (p<0.001). On JDI, 95.5% journals demonstrated poor diversity. Moreover, 72.7% and 77.3% journals had all members of the EB belonging to the same region and the same country income level respectively. As EBs of MSJs offer opportunities for further advancement, networking, and promotion, a commitment to prioritizing diversity, equity, and inclusion accompanied by development and implementation of actionable plans and allocation of sufficient resources should be given precedence. (shrink)

In recent decades there has been an increased emphasis on non-technical skills in medical teams. One promising approach that relates teamwork to medical efficiency is the theory of Shared Mental Models. The aim of the present study was to investigate the suitability of the Shared Mental Model approach for teamwork between operators in emergency medical communication centers and the first line ambulance personnel in real-life settings. These teams collaborate while working from geographically dispersed positions, which makes them distinct from the (...) kinds of teams examined in most previous research on team effectiveness. A pressing issue is therefore whether current models on co-located teams are valid for medical distributed teams. A total of 240 participants from 80 emergency medical teams participated in the study. A team effectiveness model was proposed based on identified team coordinating mechanisms and the “Big five” team processes. Path analyses showed that SMM was positively associated with team effectiveness and negatively related to mission complexity. Furthermore, the coordinating mechanisms of SMM and Closed Loop Communication was positively related to “Big five” team scores. However, no effects were found for the “Big five” team processes on effectiveness, which could indicate that the model needs to be adjusted for application to geographically dispersed teams. Possible implications for team training of distributed emergency response teams are discussed. (shrink)

This introduction to the third and final part of the Common Knowledge symposium “Unsocial Thought, Uncommon Lives” is reprinted here in a special issue of representative pieces from the journal’s first twenty-five years. The title is taken from an article by Isaiah Berlin in CK. Perl’s essay argues against the Aristotelian presumption that “man is a social animal” and explains that the CK symposium on unsocial thought was meant to substantiate that “societies do as a rule smother instinctive behaviors, but (...) in the process they also as a rule incarnate the least respectable instincts with greater force than individuals can do independently.... If even heroism and altruism, let alone standard social conduct, are oblique expressions of aggression, cruelty, and the will to power, then the obvious conclusion to reach is that human beings are not fit company for each other.... The standard means of veering off from this conclusion is to blame one’s own society, or aspects of contemporary society, and then to propose improvements. Historically, evidence suggests, efforts of this kind are opportunities for controversy and thus for exercise of the will to power. Social order is such that even the discussion of social order occasions conflict.” Perl goes on to argue that individualists and communitarians are “fundamentally in accord”: they are “teams” agreeing to the rules of a dubious conflict from which only “stylites, dendrites, and mendicants” have done what is required to exempt themselves. (shrink)

BackgroundThe participant recruitment process is a key ethical pivot point when conducting robust research. There is a need to continuously review and improve recruitment processes in research trials and to build fair and effective partnerships between researchers and participants as an important core element in ensuring the ethical delivery of high-quality research. When participants make a fair, informed, and voluntary decision to enroll in a study, they agree to fulfill their roles. However, supporting study participants to fulfill study requirements (...) is an important ethical obligation for researchers, yet evidenced as challenging to achieve. This paper reports on participants’ motivations to volunteer and remain part of a dietary study conducted in Kasungu District, Malawi.MethodsWe conducted twenty in-depth interviews (with chiefs, religious leaders, trial participants, and health surveillance assistants), five systematic ethnographic observations, and fourteen focus group discussions with trial participants and their partners. Interviews were audio-recorded and transcribed verbatim. We used a grounded theory methodology to analyse data that included coding, detailed memo writing, and data interpretation.FindingsThe findings reveal that many participants had concerns during the trial. Thematically, experiences included anxieties, mistrust of researchers, rumours, fears of exploitation, and misconceptions. Anonymous concerns collected from the participants were reported to the trial team which enabled the researchers to appropriately support participants. Despite initial concerns, participants described being supported and expressed motivation to take up their role.ConclusionThese findings highlight a diverse map of multiple notions of what is ethically relevant and what can impact participation and retention within a study. The study has revealed how embedding a responsive approach to address participants’ concerns and ethical issues can support trust relationships. We argue for the need to employ embedded ethics strategies that enhance informed consent, focus on participants’ needs and positive experiences, and support researchers to fulfill their roles. This work highlights the need for research ethics committees to focus on the risks of undue influence and prevent exploitation especially in settings with a high asymmetry in resources and power between researcher and participant groups.Trial Registration: The Addressing Hidden Hunger with Agronomy (Malawi) trial was registered on 5th March 2019 (ISCRTN85899451). (shrink)

A systematic literature review on evaluation of clinical ethics support services in mental healthcare is presented and discussed. The focus was on (a) forms of clinical ethics support services, (b) evaluation of clinical ethics support services, (c) contexts and participants and (d) results. Five studies were included. The ethics support activities described were moral case deliberations and ethics rounds. Different qualitative and quantitative research methods were utilized. The results show that (a) participants felt that they gained an increased insight into (...) moral issues through systematic reflection; (b) there was improved cooperation among multidisciplinary team members; (c) it was uncertain whether clinical ethics support services led to better patient care; (d) the issue of patient and client participation is complex; and (e) the implementation process is challenging. Clinical ethics support services have mainly been studied through the experiences of the participating facilitators and healthcare professionals. Hence, there is limited knowledge of whether and how various types of clinical ethics support services influence the quality of care and how patients and relatives may evaluate clinical ethics support services. Based on the six excluded ‘grey zone articles’, in which there was an implicit focus on ethics reflection, other ways of working with ethical reflection in practice are discussed. Implementing and evaluating clinical ethics support services as approaches to clinical ethics support that are more integrated into the development of good practice are in focus. In order to meet some of the shortcomings of the field of clinical ethics support services, a research project that aims to strengthen ethics support in the mental health services, including patients’ and caregivers’ views on ethical challenges, is presented. (shrink)

The COVID-19 pandemic outbreak has led to a general reorganization of health services and an increase in outpatient telemedicine in mental healthcare for physically ill people. Current literature highlights facilitators and obstacles concerning the use of new technologies in psychotherapy, an underrated topic of research in the context of supportive expressive psychotherapy. More insight is needed to explore the characteristics of video in therapeutic alliance for treatment of specific mental disorders experienced in psychosomatics, particularly with people suffering from a disturbed (...) body- and self-image. Using two clinical vignettes, it is the authors’ intention to enrich the critical debate on current knowledge in psychosomatic remote psychotherapy, with special focus on mentalization deficits and their impact on therapeutic alliance in the consultation-liaison psychiatry setting. In particular, we will question the interpersonal processes at stake related to mirroring and the disruption caused by the use of videoconference applications. We will also reflect upon the relationship between the therapeutic alliance and the medical team, and that between patient and psychotherapist. The aim is to improve psychotherapeutic alliance maintained during the pandemic for specific mental disorders and to inform about possible clinical factors that could be the subject of future empirical studies or professional guidelines. (shrink)